Hub overviewParaneoplasticICD-10 various
Paraneoplastic skin signs — overview
Paraneoplastic dermatoses · cutaneous paraneoplastic syndromes
Paraneoplastic skin signs are dermatological manifestations of an underlying internal malignancy that are not caused by direct invasion, metastasis or treatment. Their recognition is a powerful diagnostic clue, sometimes preceding the cancer by months. UK clinical practice groups them by morphology and underlying cancer association. This page is a navigational hub linking to individual monographs.
CurrentLast reviewed 16 May 2026
Concept and criteria
- Curth (1976) criteria for paraneoplastic dermatoses:
- Concurrent onset with malignancy.
- Parallel course (skin sign improves with tumour treatment; recurs with relapse).
- Specific tumour-skin association.
- Statistical link.
- Genetic syndrome association — the most variably reported criterion; the first four are the core Curth postulates.
- Strong vs weak paraneoplastic associations vary; some are diagnostic of malignancy until proven otherwise.
Classical paraneoplastic dermatoses
- Acanthosis nigricans — gastric adenocarcinoma; tripe palms; sign of Leser-Trélat overlap.
- Necrolytic migratory erythema — glucagonoma (4-D).
- Erythema gyratum repens — wood-grain figurate erythema; lung / breast / GI.
- Bazex acrokeratosis paraneoplastica — acral psoriasiform; upper-aerodigestive SCC.
- Sign of Leser-Trélat — eruptive seborrhoeic keratoses; GI adenocarcinoma.
- Howel-Evans syndrome — focal palmoplantar keratoderma + oesophageal SCC; RHBDF2.
- Trousseau sign — migratory superficial thrombophlebitis; pancreatic / lung adenocarcinoma.
- Paraneoplastic pemphigus — NHL / CLL / Castleman; bronchiolitis obliterans.
- Paraneoplastic dermatomyositis — heliotrope, Gottron, shawl sign; ovarian / lung / NPC.
- Acquired hypertrichosis lanuginosa — lanugo hair; lung / GI / breast.
- Multicentric reticulohistiocytosis — coral-bead periungual; ~25-30% paraneoplastic.
- POEMS syndrome — glomeruloid haemangiomas; plasma cell dyscrasia.
- Erythroderma — ≥90% BSA; CTCL / Sézary / paraneoplastic.
- Acquired ichthyosis — Hodgkin (commonest).
- Pruritus of malignancy — Hodgkin, polycythaemia, CTCL.
- Anetoderma — CTCL / lymphoma association.
Cancer-specific associations
- Internal adenocarcinoma (GI / lung): acanthosis nigricans, tripe palms, sign of Leser-Trélat, erythema gyratum repens, acquired hypertrichosis lanuginosa, Trousseau.
- Lymphoma / haematological: acquired ichthyosis (Hodgkin), pruritus of malignancy, paraneoplastic pemphigus (NHL / CLL / Castleman), anetoderma, erythroderma.
- Upper aerodigestive SCC: Bazex acrokeratosis, Howel-Evans.
- Plasma cell dyscrasia / myeloma: POEMS, scleromyxoedema, necrobiotic xanthogranuloma.
- Solid organ malignancy: dermatomyositis, eruptive xanthomas (rare), migratory thrombophlebitis.
- MEN-2B / endocrine: mucosal neuromas, cafe-au-lait, ganglioneuromatosis.
Workup when paraneoplastic suspected
- Full history including B-symptoms (weight loss, night sweats, fever), recent skin change, systems review, family history.
- Full skin and mucosal examination; lymphadenopathy; hepatosplenomegaly.
- Bloods: FBC, U&E, LFT, CRP, ESR, LDH, calcium, ferritin, thyroid function, serum / urine protein electrophoresis.
- HIV, HBV / HCV, HTLV-1 (lymphoma).
- Age- / sex-appropriate cancer screening — mammography, cervical, FIT / colonoscopy, gastroscopy if symptoms.
- CT chest / abdomen / pelvis if persistent unexplained / B-symptoms.
- PET-CT for suspected lymphoma / occult primary.
- Skin biopsy of any persistent / atypical lesion with appropriate IHC.
Practical points
- Threshold for malignancy workup should be low when classical paraneoplastic sign present.
- Time-course: paraneoplastic sign may precede cancer diagnosis by months (acanthosis nigricans, AHL, EGR).
- Resolution with cancer treatment is supportive evidence.
- Communicate to GP / cancer MDT promptly; document red-flag rationale.
- NICE NG12 (suspected cancer): generalised >6 weeks pruritus, unexplained lymphadenopathy, weight loss → 2-week-wait referral consideration.
References
- Curth HO. Skin lesions and internal carcinoma. Cancer Med. 1976.
- Boyce S, Harper J. Paraneoplastic dermatoses. Dermatol Clin. 2002;20:523-532.
- Yuste-Chaves M, Unamuno-Pérez P. Cutaneous alerts in systemic malignancy. Actas Dermosifiliogr. 2013;104:285-298.
- NICE NG12. Suspected cancer: recognition and referral. London: NICE; 2015 (last updated 15 April 2026).
Spot a correction?
If any clinical statement, citation or link on this page needs updating, please email admin@skinoncology.net with the page name, the proposed correction and the supporting source.