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Systemic dermatology

Signs of internal malignancy key points test

For each condition, select the most appropriate description:

Acanthosis nigricans * Honeycomb keratoderma of hands, feet *! Associated with insulin resistance and obesity * Heliotrope eyelids and erythematous papules over the knuckles * Crusting erosions around mouth, nose and genitals Explanation: Acanthosis nigricans describes hyperpigmented velvety thickening of neck, axillae and other body folds. It is associated with insulin resistance, obesity and malignancy. Dermatomyositis * Honeycomb keratoderma of hands, feet * Associated with insulin resistance and obesity *! Heliotrope eyelids and erythematous papules over the knuckles * Crusting erosions around mouth, nose and genitals Explanation: Dermatomyositis results in heliotrope eyelids and erythematous papules on knuckles (Gottron's papules). In the elderly, it is associated with malignancy. Paraneoplastic acrokeratosis *! Honeycomb keratoderma of hands, feet * Associated with insulin resistance and obesity * Heliotrope eyelids and erythematous papules over the knuckles * Crusting erosions around mouth, nose and genitals Explanation: Paraneoplastic acrokeratosis is a honeycomb keratoderma of hands, feet, nose and ears associated with squamous cell carcinoma of upper respiratory or gastrointestinal tracts. Necrolytic migratory erythema * Honeycomb keratoderma of hands, feet * Associated with insulin resistance and obesity * Heliotrope eyelids and erythematous papules over the knuckles *! Crusting erosions around mouth, nose and genitals Explanation: Necrolytic migratory erythema results in crusting erosions around mouth, nose and genitals and is associated with glucagonoma. Which of the following conditions are associated with non-Hodgkin’s lymphoma? #! Acquired ichthyosis # Eruptive seborrhoeic keratoses #! Paraneoplastic pemphigus # Erythema gyratum repens Explanation: Skin signs of non-Hodgkin's lymphoma include primary lesions, generalised pruritus, acquired ichthyosis and paraneoplastic pemphigus. Which of the following red scaly plaques is not associated with internal malignancy? * Squamous cell carcinoma in situ * Extramammary Paget’s disease *! Psoriasis * Kaposi’s sarcoma Explanation: Red scaly plaques may be Kaposi's sarcoma (with internal lesions), squamous cell carcinoma in situ (when due to arsenic, associated with internal malignancy), and extramammary Paget's disease (associated with malignancy of GI and GU tracts).