Posts for tag: breast cancer

By Robert J Weiss MD PC
September 05, 2018
Category: Uncategorized

                    Did you know that the new onset of dry skin-called ichthyosis or "fish scale skin" in adult life

and which does not respond to lubricating creams may be related to a type of internal cancer,especially a

type of malignancy  called Hodgkins disease which is a type of lymphoma although the use of some

medications and some benign conditions such as hypothyroidism and sarcoidosis as well as malnutrition

may be the cause.

                   Acquired ichthyosis (or dry skin) has also been related to other internal cancers including

reticulolymphosarcoma,T-cell lymphoma,multiple myeloma, and lung,breast and cervical cancers.

                 In addition,this dry skin of adulthood not responding to lubricating creams can also occur in

people suffering from leprosy,AIDS,tuberculosis,and typhoid fever.

                Also, carcinomas originating in many internal body areas have a very high frequency to

metastasize(ie,spread) to the skin. In one large reported study of internal cancers there was a 5 % spread

to the skin and in 0.8 % the skin metastasis was the first sign of the internal malignancy.

               These skin metastases often present as erythematous( red) ,painless,and rapidly growing

solitary or multiple skin nodules(a small rouded lump) on the skin  or under the skin .

             Usually, the location correlates with the underlying carcinoma,ie,breast cancers most commonly

spread to the anterior(ie,front ) chest wall.

             Again,the teaching point is to get an exam by your healthcare provider for any change in

color,shape,texture or size of your skin.

 

 

 

 

 

 

 

By Robert J Weiss, MD PC
March 17, 2017
Category: Uncategorized

 

       Did you know that non-melanoma skin cancer is the most common malignancy in the United States ?

       Breast cancer followed by lung cancer rank # 2 and # 3 respectively.

       And primary lung cancer,or bronchogenic carcinoma,is the leading cause of cancer deaths in both

men and women. 

       About 85 % of lung cancers of all types are linked to smoking.

      The majority of the other 15 % of lung cancers not related to smoking are found in women for 

reasons not clearly known,although exposure of the chest cavity to radiation as well as exposure

to environmental toxins such as asbestos and radon are also linked to an increase risk of developing

lung cancer.

       Now,getting back to skin cancer,I find it extremely interesting that a type of skin cancer called the

Merkel cell carcinoma and, which is extremely aggressive, is of neuroendocrine origin(please see my previous

post on merkel cell carcinoma) as is a type of lung cancer,previously known as oat-cell)and now called

small cell cancer which has an eighty percent rate of metastasis at the time of diagnosis.And,is obviously

also extremely aggressive.

      In my opinion,a diagnosis of merkel cell skin cancer is one of the most serious diagnoses in

dermatology- in many cases more so than malignant melanoma,depending on the latter's depth and

staging at the time of diagnosis.

     The FDA has recently approved the drug Bavenicio( known chemically as avelumab) to treat metastatic

merkel cell carcinoma(which means it has spread to other parts of the body). And,about 1600 people in

the USA are diagnosed with merkel cell carcinoma annually.

 

 

       

 

      

                A few years ago one of my male patients presented with a groin rash of several months duration

which was unresponsive to various topical antifungals and topical corticosteroids  prescribed by his health care

practitioner.

              The rash was red and scaly encompassing his groin and extending to his scrotal area.There was

associated itching and burning at times. The most important clue here was that the rash had been  chronically

unresponsive to the above measures.

             Consequently,I suspected a condition called extra mammary Paget's disease (EMPD) which

fortunately is a rare  cancerous condition of apocrine gland-bearing sites.

             In addition,two types of EMPD have been described:the primary type thought to arise from a stem

cell within genital skin and not associated with an underlying internal malignancy involving the rectum

and/or other internal body areas.However,the primary type is still a carcinoma of the skin and needs to

be treated.

             Secondary EMPD is the more dangerous type since it is associated with an underlying adnexal

(connected) adenocarcinoma or an underlying visceral(internal) cancer and is the same as mammary

Paget's disease  of the breast(nipple). 

           Fortunately,I referred my patient to a general surgeon for a deep excisional biopsy which confirmed

my clinical diagnosis.The presence of a cellular protein called cytokeratin 20  helps to differentiate

between the primary and secondary types on biopsy.

           In addition,the presence of a gene called HER-2  in the biopsy specimen may indicate a high risk

for lymphatic spread and the need to follow the patient very diligently.

          EMPD most frequently involves the vulva in women,the perianal area,perineum,scrotum,penis and

axillae(armpits). Treatment includes wide surgical excision,radiation therapy,and several topical(external)

agents.

 

 

 



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