Florid cutaneous papillomatosis

Florid cutaneous papillomatosis (FCP), is an obligate paraneoplastic syndrome.

Florid cutaneous papillomatosis
Other namesSchwartz–Burgess syndrome
SpecialtyDermatology

FCP begins as the sudden onset of numerous cutaneous papillomas that are clinically indistinguishable from viral warts. The papillomas range from 1 to 3 mm in diameter may spread to involve the entire body, including the face. Pruritus, which may sometimes precede the onset of FCP, is evident in the affected regions in about half of patients. Evaluation of a skin biopsy clearly distinguishes FCP from viral warts.

FCP is associated with underlying cancer of the breast, bladder, ovary, uterus, prostate, and lung. Other associated underlying malignancies include squamous cell carcinomas and lymphomas such as non-Hodgkin's lymphoma.

FCP is sometimes seen together with other signs of internal cancer, especially malignant acanthosis nigricans, tripe palms, Leser–Trélat sign, and hypertrichosis lanuginosa acquisita. FCP tends to improve in association with surgical or chemotherapeutic therapy of the underlying internal cancer. A recurrence or exacerbation of FCP may be linked with tumor regrowth or metastatic spread.

Signs and symptoms

The characteristic eruption is of multiple warty papules and nodules beginning on acral skin, especially the hands and wrists, and disseminating onto the skin of the entire body. These skin lesions develop on the trunk, extremities, and face.[1]: 63  Pruritus is also associated.

Causes

The etiology of florid cutaneous papillomatosis is unknown. It is likely directly induced by an underlying neoplasm secreting a growth factor. One candidate may be alpha-transforming growth factor, structurally related to epidermal growth factor, but antigenically distinct from it. The underlying cancer is most often gastric adenocarcinoma[1]: 63 [2][3] but also with breast cancer, bladder cancer, hepatobiliary cancer, ovarian cancer, uterine cancer,[4] prostate cancer, lung cancer[5] and cervical cancer.[6] Other associated underlying malignancies include squamous cell carcinomas and lymphomas.[7]

Pathophysiology

Florid cutaneous papillomatosis, malignant acanthosis nigricans, and the sign of Leser-Trélat may be highlighted as part of a continuum, with each having a common or similar pathogenic pathway due to an underlying malignancy that produces a factor epidermal growth factor-like activity.

Diagnosis

The sudden eruption of papulonodules usually indistinguishable from common viral warts should suggest this diagnosis. These papulonodules begin on the extremities, especially on the dorsa of the hands and the wrists and may disseminate to involve the entire body, including the face.[8] The papulonodules may vary in size from 2–3 mm to 10 mm in diameter. Pruritus is often associated.

Florid cutaneous papillomatosis is linked with an underlying cancer. Malignant acanthosis nigricans may also become evident, many times with the sudden eruption of multiple seborrheic keratoses, known as the sign of Leser-Trélat.[9][10][11] Florid cutaneous papillomatosis mandates a search for an underlying malignancy, recognizing that it may be seen in patients with multiple visceral carcinomas. Histologic examination shows uniform and pronounced hyperkeratosis, acanthosis, and papillomatosis without epidermal vacuolization, parakeratosis, or eosinophilic inclusions suggestive of viral warts.[12]

The sudden quality of the eruption of florid cutaneous papillomatosis and its anatomic distribution should facilitate distinction from widespread common warts and from epidermodysplasia verruciformis.

Treatment

Identifying and treatment the underlying malignancy constitutes an uptime approach. Topical 5-fluorouracil may occasionally be help, as may oral retinoids, topical steroids, vitamin A acid, urea, salicylic acid, podophyllotoxin, and cryodestruction employing liquid.

Prognosis

Improvement usually parallels that of the cancer, whether surgical or chemotherapeutic. Generalization of the associated visceral malignancy may worsen the eruption.

Epidemiology

Florid cutaneous papillomatosis is almost twice as common in men than in women, and is usually diagnosed in individuals aged 53–72 years (mean patient age, 58.5 years).[1]: 66 

History

Florid cutaneous papillomatosis was discovered by Robert A. Schwartz and Gordon H. Burgess.[13] The original description was published in the Archives of Dermatology,[14] which is published by American Medical Association. It has since been called Schwartz–Burgess syndrome.[15][16]

Society and culture

Patients may have their unaesthetic appearance resulting in isolation from their community, feeling or being unwelcome in public places.[17]

References
  1. Mansouri, P.; et al. (1999). "Florid cutaneous papillomatosis, malignant acanthosis nigrica, palmoplantar keratoderma, and gastric adenocarcinoma" (PDF). Acta Medical Iranica. 37 (1). Archived from the original (PDF) on 2011-07-22. Retrieved 2009-02-18.
  2. Singhi, M.K.; et al. (2005). "Florid cutaneous papillomatosis with adenocarcinoma of stomach in a 35 year old male" (PDF). Indian J Dermatol Venereol Leprol. 71 (3): 195–6. doi:10.4103/0378-6323.16238. PMID 16394412.
  3. Klieb, HB.; Avon, SL.; Gilbert, J.; Sade, S.; Enepekides, D. (May 2013). "Florid cutaneous and mucosal papillomatosis: mucocutaneous markers of an underlying gastric malignancy". J Clin Oncol. 31 (13): e218–9. doi:10.1200/JCO.2012.45.2151. PMID 23530104.
  4. Yoon Oo Noh, G.C.L.; Mi Kyeong Kim; Youn Soo Kim; Tae Young Yoon (2002). "A Case of Florid Cutaneous Papillomatosis and Tripe Palm". Korean J Dermatol. 7 (40).
  5. Bottoni U, Dianzani C, Pranteda G, et al. (May 2000). "Florid cutaneous and mucosal papillomatosis with acanthosis nigricans revealing a primary lung cancer". J Eur Acad Dermatol Venereol. 14 (3): 205–8. doi:10.1046/j.1468-3083.2000.00051.x. PMID 11032067.
  6. Tsai, Yu-Ju; Tsai, Yi-Jeng; Chuan, Ming-Tuo; Hu, Shu-Ling (2004), "The Combination of Tripe Palms, Acanthosis Nigricans and Florid Cutaneous Papillomatosis in a Patient with Metastatic Cervical Cancer", Dermatol Sin, 22: 142–147
  7. Janier, M.; Blanchet-Bardon, C.; Bonvalet, D.; Lenoble, M.; Boiget, F.; Civatte, J. (1988). "Malignant Acanthosis nigricans Associated with Non-Hodgkin's Lymphoma". Dermatology. 176 (3): 133–137. doi:10.1159/000248689. ISSN 1421-9832.
  8. Norman Levine; Carol C. Levine (12 February 2004). Dermatology Therapy. A - Z Essentials. Springer. p. 242. ISBN 978-3-540-00864-4.
  9. Mark G. Lebwohl; Warren R. Heymann; John Berth-Jones; Ian Coulson (8 December 2009). Treatment of Skin Disease: Comprehensive Therapeutic Strategies. Elsevier Health Sciences. p. 88. ISBN 978-0-7020-4328-4.
  10. Judith Collier; Murray Longmore; Keith Amarakone (31 January 2013). Oxford Handbook of Clinical Specialties. Oxford University Press. p. 589. ISBN 978-0-19-959118-3.
  11. Connie Henke Yarbro; Debra Wujcik; Barbara Holmes Gobel (15 November 2010). Cancer Nursing: Principles and Practice. Jones & Bartlett Publishers. p. 1902. ISBN 978-1-4496-5781-9.
  12. David Weedon; Geoffrey Strutton (1997). Skin pathology. Churchill Livingstone. p. 640. ISBN 978-0-443-05575-1.
  13. Chou, Che-Yi; Yeh, Shih-Wei (2012). "Multiple brownish warty papulonodules on left dorsal hand". Dermatologica Sinica. 30 (2): 81–82. doi:10.1016/j.dsi.2011.10.004. ISSN 1027-8117.
  14. Schwartz RA, Burgess GH (December 1978). "Florid cutaneous papillomatosis". Arch Dermatol. 114 (12): 1803–6. doi:10.1001/archderm.114.12.1803. PMID 153731.
  15. Yang, YH.; Zhang, RZ.; Kang, DH.; Zhu, WY. (2013). "Three paraneoplastic signs in the same patient with gastric adenocarcinoma". Dermatol Online J. 19 (7): 18966. PMID 24010512.
  16. Gao, Xing-Hua; Chen, Hong-Duo (2013). "Professor Robert A. Schwartz Awarded Title of Honorary Professor, China Medical University, Shenyang, November 20, 2012". International Journal of Dermatology. 52 (2): 262. doi:10.1111/ijd.12131_2. ISSN 0011-9059.
  17. Csete, B.; Moezzi, M.; Lengyel, Z.; Hodosi, B.; Zombai, E.; Battyáni, Z. (Sep 2005). "Florid cutaneous papillomatosis leading to social exclusion". Br J Dermatol. 153 (3): 667–9. doi:10.1111/j.1365-2133.2005.06772.x. PMID 16120165.

Bibliography
  • Weger W, Ginter-Hanselmayer G, Hammer HF, Hödl S (November 2007). "Florid cutaneous papillomatosis with acanthosis nigricans in a patient with carcinomas of the lung and prostate". J. Am. Acad. Dermatol. 57 (5): 907–8. doi:10.1016/j.jaad.2006.02.002. PMID 17939948.
  • Dennis Albert Casciato; Mary C. Territo (2009). Manual of Clinical Oncology. Lippincott Williams & Wilkins. p. 588. ISBN 978-0-7817-6884-9.
  • Schwartz RA (1993). "Florid cutaneous papillomatosis". Clin. Dermatol. 11 (1): 89–91. doi:10.1016/0738-081X(93)90102-I. PMID 8339205.
  • De Backer J, Kint A (1971). "Malignant acanthosis nigricans with multiple verrucous formations". Arch Belg Dermatol Syphiligr. 27 (3): 317–22. PMID 5151960.
  • Dennis Albert Casciato; Barry Bennett Lowitz (1995). Manual of Clinical Oncology. Little, Brown. p. 477. ISBN 978-0-316-13279-4.
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