56-Year-Old With Cancer and Developing Rash

Differential Diagnosis

• Acrokeratosis paraneoplastica
• Dermatomyositis
• Palmoplantar keratoderma
• Psoriasis

Diagnosis

The correct diagnosis is acrokeratosis paraneoplastica. Also known as Bazex syndrome, it is a paraneoplastic dermatosis characterized by scaly, erythematous plaques that is commonly seen with squamous cell carcinomas of the upper aerodigestive tract and cervical lymphadenopathy from metastatic disease. Acrokeratosis paraneoplastica may appear prior to the diagnosis of an underlying malignancy.

What to Look For

• Findings of plaques like psoriasis located on the nose, ears, fingers and toes
• Associated alopecia, plantopalmar keratoderma, and nail changes may also be present

Pearls for Urgent Care Management

• If diagnosed, ensure the patient pursues malignancy work-up if current cancer diagnosis is not present
• Treatment of underlying malignancy may resolve cutaneous symptoms
• The most common direct treatment is oral acitretin