George Y. Wu (editor) - Atlas of Dermatological Manifestations of Gastrointestinal Disease

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Part 1
Dysphagia

George Y. Wu , Nathan Selsky and Jane M. Grant-Kels (eds.) Atlas of Dermatological Manifestations of Gastrointestinal Disease 2013 10.1007/978-1-4614-6191-3_1 Springer Science+Business Media New York 2013

1. Oropharyngeal Cancer: Gastrointestinal Features

Laura Nieves 1

(1)

Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, USA

Laura Nieves

Email:

Abstract

Oropharyngeal cancer comprises the malignant pathologies involving the tissues of the oropharynx. This includes the tongue, tonsils, soft palate, and walls of the pharynx. These cancers are generally divided into those that are human papillomavirus (HPV)-positive and those that HPV-negative (generally related to smoking or alcohol).

Oropharyngeal cancer comprises the malignant pathologies involving the tissues of the oropharynx. This includes the tongue, tonsils, soft palate, and walls of the pharynx. These cancers are generally divided into those that are human papillomavirus (HPV)-positive and those HPV-negative (generally related to smoking or alcohol). The gastrointestinal (GI) symptoms include []:

• Persistent sore throat
• Unusual bleeding, swelling, pain, or numbness in mouth
• Taste abnormalities
• Dysphagia
• Odynophagia
• Otalgia
• Hoarseness

The most frequent clinical signs and findings are []:

• Nonhealing sores or ulcers in oral cavity (pain or painless)
• Red or white lesion with an irregular, fungating growth; surface ulcerations; easy bleeding ( see Fig. )
• Cervical lymphadenopathy
• Associated conditions:

  • Bazexs syndrome (acrokeratosis paraneoplastica), rare, erythematous to violaceous psoriasiform plaques in acral areas. Palmoplantar keratoderma, alopecia, and nail dystrophy are common. Has also been associated with other malignancies.

Fig. 1.1

Extensive oropharyngeal carcinoma associated with Bazexs syndrome

The pathogenesis involves the usual risk factors for upper GI malignancy []:

• Chronic inflammation (thought to be precipitating factor)

  • Tobacco and alcohol (major risk factors), HPV infection
• Series of somatic or epigenetic changes allow resistance to growth-inhibitory signals, autonomous proliferation, avoidance of apoptosis, unlimited replication, angiogenesis, invasion and metastasis.

The pathology shows typical features of mucosal malignancy []:

• Squamous cell carcinoma

  • Classic pattern: infiltration of neoplastic squamous epithelial cells into supporting connective tissue stroma, which may be chronically inflamed with abundance of plasma cells and lymphocytes.

The diagnosis is made by considering the following []:

• Initial assessment by careful examination of oral cavity
• Confirmed by biopsy
• Panendoscopy (including laryngoscopy, esophagoscopy, and possible bronchoscopy) looking for other head and neck tumors
• Magnetic resonance imaging (MRI), computed tomography (CT) scan, and positron emission tomography (PET) scan for staging

The differential diagnosis of oropharyngeal cancer should include []:

• Aphthous ulcers
• Oral candidiasis
• Lichen planus
• Pyogenic granuloma
• Kaposis sarcoma
• Minor salivary gland tumors
• Oral leukoplakia
• Metastatic tumors

The treatment involves usual modalities for the treatment of malignancy [6]:

• Multimodaldepends on staging and location

  • Principal treatment modalities are surgery and radiation therapy (RT)
  • Post-surgical chemoradiation (platinum-based) for advanced disease
  • Radiotherapy plus cetuximab has survival benefit over RT alone
  • Cessation of risk factors (alcohol and tobacco)

References

Moore RL, Devere TS. Epidermal manifestations of internal malignancy. Dermatol Clin. 2008;26:1729. PubMed CrossRef

European Society for Medical Oncology (ESMO). Squamous cell carcinoma of the head and neck: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2007;18:ii656. CrossRef

Kupferman ME, Myers JN. Molecular biology of oral cavity squamous cell carcinoma. Otolaryngol Clin N Am. 2006;39:22934. CrossRef

Greer R. Pathology of malignant and premalignant oral epithelial lesions. Otolaryngol Clin N Am. 2006;39:24975. CrossRef

Chen AY. Cancer of the oral cavity. Dis Mon. 2001;47:275361. PubMed CrossRef

Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of head and neck cancer. A national clinical guideline. Edinburgh, Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2006

George Y. Wu , Nathan Selsky and Jane M. Grant-Kels (eds.) Atlas of Dermatological Manifestations of Gastrointestinal Disease 2013 10.1007/978-1-4614-6191-3_2 Springer Science+Business Media New York 2013

2. Bazexs Syndrome: Dermatological Features (Acrokeratosis Paraneoplastica)

Liam Zakko 1

(1)

Yale Department of Internal Medicine, Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, USA

(2)

Department of Dermatology, University of Connecticut Health Center, 21 South Road, Farmington, CT 06030, USA

Liam Zakko (Corresponding author)

Email:

Justin Finch

Email:

Marti J. Rothe

Email:

Jane M. Grant-Kels

Email:

Abstract

Clinical signs and features include:

Paraneoplastic syndrome characterized by acral psoriasiform lesions: red violaceous hyperkeratotic plaques with ill-defined borders; nail changes including subungual hyperkeratosis, onycholysis, longitudinal streaks, yellow pigmentation; hyperkeratotic plaques at pressure points (knees, elbows); and hyperkeratotic plaques on the ears, nose, and cheeks

Particular findings include violet discoloration and bulbous enlargement of the distal phalanges; lesions only on the helix of the ear (not entire ear like psoriasis)

Three clinical stages: (1) poorly circumscribed skin lesions on the helices of the ears, nose, cheeks, fingers, toes, and nails associated with asymptomatic carcinomas most commonly of the upper aerodigestive tract ( see Fig. 2.1b); (2) lesions which spread to the palms and soles with a locally symptomatic malignancy ( see Fig. 2.1a); (3) With an untreated malignancy, erythema and scale spread to the knees, elbows, and trunk

Clinical signs and features include:

• Paraneoplastic syndrome characterized by acral psoriasiform lesions: red violaceous hyperkeratotic plaques with ill-defined borders; nail changes including subungual hyperkeratosis, onycholysis, longitudinal streaks, yellow pigmentation; hyperkeratotic plaques at pressure points (knees, elbows); and hyperkeratotic plaques on the ears, nose, and cheeks []

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