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Acrokeratosis paraneoplastica, or Bazex syndrome, is a unique cutaneous eruption associated with internal malignant conditions, most commonly squamous cell carcinoma of the aerodigestive tract. While classic stages and sites of involvement are most often reported, atypical presentations must not be overlooked.
A man in his 60s presented with a 9-month history of slightly itchy bumps on the chest and back and 3 weeks of nail tenderness. When specifically questioned, the patient reported noticing a penile lesion 3 months earlier. Physical examination revealed multiple hyperkeratotic, erythematous and hyperpigmented papules and plaques on the chest, back, and arms (Figure 1). Hyperkeratotic patches with slight hyperpigmentation were scattered on the bilateral palms with no involvement of the soles. All fingernails had onychomadesis without dystrophy, while the toenails were normal. An erythematous scaly plaque with satellite papules was present on the glans penis (Figure 2). Face, scalp, and oral mucosa were uninvolved. A 1-cm tender, firm cervical lymph node was palpated, and on further questioning the patient reported odynophagia and dysphagia.
Graves MS, Hardin ME, Davis LS. A Case of Bazex Syndrome With Genital Involvement. JAMA Dermatol. 2014;150(12):1368–1370. doi:10.1001/jamadermatol.2014.2110
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