To the Editor.—
The entity paraneoplastic acrokeratosis of Bazex1,2 has to be regarded as a true paraneoplastic syndrome affecting middle-aged men. The sudden clinical dermatological manifestations are related to the existence of a cancer; they may disappear if the malignant growth is removed, but appear again if there is a recurrence of tumor.3 The cutaneous changes must alert the physician to search the upper respiratory and digestive tract for a malignant tumor, always a carcinoma, before it begins to produce it's own signs and symptoms.The lesions are symmetrically located on the extremities, involving hands, feet, ears, and, rarely, the nose (Figure). Ungual involvement is constant and also the earliest manifestation. The nails are deformed by subungal hyperkeratosis that lifts their free edge. Their surface is irregular, flaky, and whitish. When the lesions are severe, their appearance is similar to a major psoriatic onychopathy, including even total nail
Baran R. Paraneoplastic Acrokeratosis of Bazex. Arch Dermatol. 1977;113(11):1613. doi:10.1001/archderm.1977.01640110133039
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