Additional Neoplasms of the Skin

Paget's Disease of Skin

• Seen in 1-4% of breast cancers, this is an intraductal carcinoma that extends (in a retrograde fashion) into the overlying epidermis through the mammary duct epithelium. It presents as eczema (dermatitis) of the breast. Special Paget cells are seen microscopically, and it is probably a good idea to note that Paget’s disease can occur in supernumerary breasts as well as ectopic breast tissue.

Extramammary Paget’s Disease

…can occur in a variety of places including sweat glands, prostate, bladder, and endocervix. (slide shows EPD in the gluteal region.)

Malignancies that mimic primary dermatitis

…include Paget’s Disease (both breast and extramammary), erythroplasia of Queyrat and other erythroplasias, inflammatory metastatic carcinomas, Bowen’s disease, cutaneous t-cell lymphoma, and amelanotic lentigo maligna melanoma (rare).
 

Acanthosis Nigracans

• Rapid onset and sudden spread of dark, velvety skin thickenings that appear around the neck, axillae and groin. Causes can be either an underlying aggressive adeocarcinoma or insulin resistance (benign, usually seen in the obese). It tends to be associated with cancer only if fulminant, and may be seen concurrently with eruptive seborrhaic keratoses.

Peutz-Jegher’s Syndrome

• This is an autosomal dominant disease that presents with pigmented macules on the skin and oral mucosa. They are present from birth. Small polyps appear in the bowel (w/ recurrent intussusceptions), as well as in the stomach, colon and rectum (these bleedà anemia). Eventually, this can lead to intestinal cancer (2-3%). Ovarian neoplasms, especially granulose cell tumors, and bilateral breast cancer are other possibilities.

Kaposi's Sarcoma

• Kaposi's Sarcoma is an unusual cancer is seen mostly in older men of Mediterranian, Jewish lineage and in blacks of Uganda, Congo, and Rwanda. It also appears in homosexual men and the iatrogenically immunosuppressed.
• Kaposi's Sarcome lesions present as violacious (purple) nodules and plaques. It is associated with AIDS (think immunosupressed) and requires the presence of human herpes virus 8. However, the presence of HHV8 alone is not sufficient to cause Kaposi’s Sarcoma.

Langerhans Cell Histiocytosis

• Lesions are closely set petchiae and yellow-brown papules topped with scale and crust that coalesce into an erythematous, weeping eruption mimicking seborrheic dermatitis (especially in kids). Ulcerated plaques also appear in the axillae and anogenital regions.
• Often seen in diabetes insipidus and osteolytic lesions.
• Correct diagnosis is determined via histologic examination.

Cutaneous T-Cell lymphoma. (mycosis fungoides)

• Caused by expansion of a clone of CD4+ memory cells; considered to be a lymphoma of these cells. Localizes onto skin as dermatitis that progresses to a plaque and finally ends up as a tumor.
• It is as common as Hodgkin’s Disease

Cutaneous metastases

• In general, it is important to know that primary cancers from elsewhere can metastasize to the skin. The lesions can resemble other disorders, often they will present before symptoms of the primary cancer do.

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