This document describes the case of a 59-year-old female smoker who presented with palmoplantar hyperkeratosis and fissures that had progressed despite treatment. Further testing revealed a lung mass and small cell lung carcinoma. Given the cutaneous findings and cancer diagnosis, the condition was determined to likely be Bazex syndrome, a rare paraneoplastic phenomenon associated with squamous cell carcinoma and other tumors characterized by acral erythematous plaques, onychodystrophy, palmoplantar keratoderma, and alopecia. While palmoplantar keratoderma often has benign causes, this case demonstrated the importance of considering paraneoplastic syndromes like

1. IV Balearic Meeting of European Residents and
GP of IBAMFIC
Palmoplantar keratoderma in smoker patient
Cerdó Ensenyat, M.; López Díaz, A.C.
Palmoplantar hyperkeratosis and fissures
Woman, 59 years old. Working as Chef. Smoker. COPD. Refer since 8
months ago palmoplantar hyperkeratosis associated with
onychodystrophy that has progressed despite treatment with high
potency topical corticosteroids, keratolytic and mitotic inhibitor
treatment (oral and topical). It associate weight loss of about 7 kg in the
last 15 days. She hasn’t cought, depositional alteration or other
symptoms.
Study was completed by body CT and PET-CT that confirmed the presence of lung mass with adenopathic
parahiliar conglomerate without metastases. Bronchoscopy confirmed the presence of a small cell carcinoma.
Given these findings, cutaneous syndrome Bazex was oriented. This is a rare paraneoplastic phenomenon
associated with squamous cell carcinoma of the upper aerodigestive tract, described as associated with other
tumors though. It comes in the form of erythematous psoriasiform plaques mainly located in acral locations. It
can be associated with onychodystrophy, palmoplantar keratoderma and alopecia.
In most patients, skin manifestations precede the diagnosis of neoplasia, but up to a third of cases it is
diagnosed at the same time or before the Sde Bazex.
Palmoplantar keratoderma is a frequent reason for consultation in primary care and most often has a genetic
component and may be associated with external factors. In most cases it has a benign course and responds
favorably to treatment with emollients and topical steroids. Should bad evolution occur, the differencial
diagnosis must be extended and think of entities as Bazex Syndrome.
Hyperkeratosis and fissures in palms and soles of the feet with nail pitting and subungual
hyperkeratosis. Some hyperkeratotic and erythematous plaques on extensor areas and one in occipital
region. Cardiopulmonary auscultation: normal. Abdomen: normal No palpable lymphadenopathy.
Reason for consultation
Relevant medical history
Physical examination
Complementary tests
Diagnosis orientation/Differential diagnosis
Treatment
Evolution and conclusions
Bibliography
· Humphrey SR, Hussain AS, Chandran R, Wilson B, George B. Acute Onset of Acrokeratosis Paraneoplastica (Bazex Syndrome). JAMA
Dermatol. 2015 Jun;151(6):677-8
·Uptodate. Teresa S Wright, MD, FAAD, FAAP. The genodermatoses. Feb 22, 2016. http://www.uptodate.com/
· Uptodate. Josep Dalmau, MD, PhD, Myrna R Rosenfeld, MD, PhD. Overview of paraneoplastic suyndromes of the nervous system. Aug
10, 2016. http://www.uptodate.com/
· Robert M, Gilabert M, Rahal S, Ries P, Raoul JL. Bazex syndrome revealing a gastric cancer. Case Rep Oncol. 2014 Apr 30;7(1):285-7.
Analytical anodyne. Chest XR: parahiliar right mass
(pulmonary VS mediastinal)
Hyperkeratosis: Palmoplantar psoriasis, contact eczema,
pityriasis rubra, paraneoplastic syndrome.
Parahiliar mass : Lymphadenopathy, Lymphoma, teratoma,
Sarcoidosis, inflammatory pseudotumor, granuloma,
pulmonary neoplasia or another cause with pulmonary
metastases.
Oral retinoids // Treatment for the base disease.