Acrokeratosis Can Be a Warning Sign of an Underlying Malignancy

INTRODUCTION: Some cutaneous manifestations can be the first presentation of an underlying malignancy. These so-called paraneoplastic syndromes can sometimes be very subtle or strongly resemble other benign cutaneous diseases. AIMS: In this report, we want to emphasize the need for further investigation of eczema-like cutaneous presentations which develop at a later age and are recalcitrant to therapy. Exclusion of an underlying malignancy needs to be considered. PATIENTS AND METHODS: A 53-year-old man with thickening of the skin, more pronounced on the hands, feet and face, was diagnosed with classic nodular sclerosing Hodgkin disease based on cutaneous presentation. RESULTS: After two rounds of chemotherapy (adriamycin, bleomycin, vinblastine and dacarbazine), the cutaneous symptoms had disappeared. After six rounds of chemotherapy and 14 months of follow-up, the patient is still in remission without recurrence of the cutaneous symptoms. CONCLUSIONS: Cutaneous symptoms recalcitrant to adequate treatment should raise suspicion and prompt further investigation to exclude an underlying malignancy. A multidisciplinary approach with the dermatology department can accelerate diagnosis and improve the patient’s prognosis. LEARNING POINTS: Skin diseases can reflect internal manifestations or diseases. Vigilance, timely recognition and a multidisciplinary approach are important in a patient with atypical cutaneous manifestations. A paraneoplastic skin syndrome should be considered in persistent skin disease not responding to treatment and starting in middle-aged patients with B symptoms.