Acrokeratosis Paraneoplastica
A 66-year-old man presented to the clinic with a 4-week history of painful, edematous, and scaly ears, a condition that was later accompanied by itchy, hyperkeratotic plaques on the palms and soles with surrounding erythema (Panels A, B, and C). The skin lesions were noted to be symmetric. Previous treatment with a 0.05% formulation of clobetasol cream was unsuccessful. He was also discovered to have an enlarged mass on the left side of his neck and weight loss of 4 kg without other B symptoms (i.e., fever, night sweats, and weight loss). Bazex’s syndrome (acrokeratosis paraneoplastica) was suspected, and cytologic analysis of the enlarged lymph node showed metastasis of a poorly differentiated squamous-cell carcinoma. The presence of a squamous-cell carcinoma of the oropharynx (tumor stage 4a, lymph-node stage 2c, and no distant metastasis) was confirmed on computed tomography and positron-emission tomography–computed tomography. The patient underwent chemoradiotherapy for 6 weeks, after which the skin condition cleared (Panels D, E, and F). Nine months after the initial diagnosis, the patient died from complications of metastatic disease.
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