Pancreatic pathology, comprising acute and chronic pancreatitis, autoimmune pancreatitis and pancreatic neoplasms, primarily presents with gastrointestinal symptoms and signs; however, it is well recognized that it can also associate a wide range of extra-digestive features. Among these systemic manifestations, cutaneous involvement plays an important role both as a diagnostic clue for the pancreatic disease itself and serving as a prognostic factor for the severity of the condition. Recognition of these cutaneous signs is, however, far from being satisfactory, all the more as some of them are relatively rare. In the current review, we discuss skin involvement in pancreatic diseases, referring to pancreatic panniculitis, cutaneous hemorrhagic manifestations, skin metastasis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema and cutaneous fistula. We highlight the clinical characteristics, treatment and prognostic value of these lesions. Better awareness among medical specialties other than dermatology is needed for detection of the skin clues associated with pancreatic pathology.

Melanoma is the most serious form of skin cancer, its incidence increases with age. Melanomas are malignant tumors that are derived from melanocytes. The most common site of involvement is represented by the skin. Melanomas are considered a major cause of premature death from cancer. Melanomas produce pigment in varying amounts and may elicit an immune response that will be reflected in the clinical appearance. Some melanomas may lack pigment. A small but significant number of melanomas are undiagnosable clinically. A history of change may be the only clue to the correct diagnosis.   We present the case of a 45-year-old woman, presented to our Dermatology Department with a rapidly changing nevus that bled with minimal trauma, located on her back.

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Sarcoidosis is a multisystemic granulomatous disease, with unknown etiology, characterized histopathologically by the development in the affected organs of some "empty" (non-caseous) granulomas. Cutaneous lesions can sometimes be the fi rst localization of the disease. We present the case of a patient with known sarcoidosis and autoimmune thyroiditis, who developed a rash spread on the trunk and limbs, for which she was treated with dermatocorticoids and antihistamines, but without signifi cant improvement. A skin biopsy was performed with histopathological examination, which revealed: at the dermal level, lympho-histiocytic infi ltrates with nodular distribution, forming several granulomas, without areas of necrosis of caseifi cation, including frequent cells with epithelioid appearance, suggestive for the diagnosis of cutaneous sarcoidosis. The patient underwent systemic cortisone therapy and hydroxychloroquine, with favorable outcome. The challenge of diagnosing this pathology is to differentiate it from a number of conditions, including: ring granuloma, cutaneous Crohn's disease, lipoid necrosis, lupus vulgaris. To establish the diagnosis of certainty, it is necessary to correlate the clinical data with the result of the histopathological examination.

Linear IgA bullous dermatosis (LABD) is a rare, immune-mediated cutaneous pathology, characterized by IgA deposits along the basal membrane. Clinically, it manifests as an eruption, consisting of vesicles and bullae, with herpetiform distribution, on erythematous and/or normal skin. The lesions are located symmetrically, at the level of the trunk and extremities. Clinically, diagnosis can be difficult because it can be easily mistaken with dermatitis herpetiformis or bullous pemphigoid.     We present the case of a 79-years-old woman, without significant comorbidities, who developed a vasculo-bullous eruption, intensely itchy, located symmetrically on trunk and extremities, evolving for 4 years. We performed a skin biopsy, with histopathological examination and direct immunofluorescence, which revealed: sub epidermal vesicular-bullous lesion and dermal infiltrate with numerous neutrophils and eosinophils; IgA - continuous linear positivity at the dermal-epidermal junction. Thus, the diagnosis of LABD was established. The treatment consisted of systemic corticosteroids, colchicine, and antihistamines, with favorable evolution.    The management of these patients can be challenging, as LABD can be induced by certain drugs, and may also be associated with lymphoid malignancies.