Acrokeratosis Paraneoplastica with Adenocarcinoma of the Colon Treated with Topical Tretinoin: CASE REPORT
A 63-year-old Korean woman visited our der- matologic clinic with an 11 month history of hyperkeratotic lesions on the palms and soles. The routine laboratory tests, including a complete blood count, liver function tests, and urine analysis revealed values all within the normal range or negative findings. The physical examination revealed yellowish punctuate hyperkeratotic lesions on the palms and soles (Fig. 1A, B), as well as onycholysis of the toenails and fingernails (Fig. 1C, D). She had no subjective symptoms, such as pruritus or pain.
Ten months previously she was admitted to the hemato-oncologic department complaining of dyspnea and one episode of hematochezia. A mass was found on the descending colon by colonoscopy. Histopathologic examination of the mass revealed an adenocarcinoma with a moderate degree of differentiation, and she underwent a left hemicolectomy. The colon cancer was classified as stage T3N1M0, thus no adjuvant therapy was required. There was no family history of cutaneous disease or cancer.
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Fig. 1. Yellowish punctuate hyperkeratotic plaques on the left palm (A) and identical lesions on the right sole (B). Onycholysis on the finger nails (C) and toenails (D).
The skin biopsy specimen from her right palm showed a thickened granular layer and scattered parakeratotic columns in the epidermis (Fig. 2A). There was acanthosis, and eosinophilic and vacuolar degeneration with exocytosis in the spinous layer (Fig. 2B). The histologic findings were compatible with keratosis palmaris et plantaris. Since the skin lesion preceded the development of colon cancer by 1 month, the patient was diagnosed with acrokeratosis paraneoplastica (Bazex syndrome).
Fig. 2. Histologic examination demonstrates (A) hyperkeratosis, a thickened granular layer, and scattered parakeratotic columns in the stratum corneum (H&E, x40) and (B) acanthosis, and eosinophilic and vacuolar degeneration with exocytosis in the spinous layer (H&E, x100).
The skin lesions were treated with topical 0.025% tretinoin cream and the skin lesions resolved completely, except for the nail dystrophies (Fig. 3). There was no recurrence during 24 months of follow-up.
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Fig. 3. Punctated keratoderma of the palms (A) and soles (B) was almost completely resolved, except for the nail dystrophies (C) after 2 months of treatment with topical tretinoin.
Tags: Acrokeratosis paraneoplastica, Bazex syndrome, Colon Cancer, Tretinoin