The link between external changes and internal malignant disease has fascinated dermatologists and internists for many years.1,2 Many important practical clinical questions must be answered if an association between a skin lesion and internal malignancy is noted, including whether or not occult malignancy should be searched for, how extensive a search should be conducted, and how often the search should be repeated. Not only are these questions important to consider for an individual patient, but the implications relating to socioeconomic, medicolegal, and psychological issues also need to be considered. If a dermatologic change is falsely associated with internal malignancy, the patient may undergo unnecessary procedures with their attendant risks, there are unnecessary costs to the individual and to the society, and there may be a potential for legal action if the search for malignant disease is not carried out "properly." Lastly, these "false" associations are not hidden from the
Callen JP. Bowen's Disease and Internal Malignant Disease. Arch Dermatol. 1988;124(5):675–676. doi:10.1001/archderm.1988.01670050019010
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