Cutaneous features seen in primary liver cell (Hepatocellular) carcinoma patients at a University Teaching Hospital in Nigeria

Abstract

SUMMARYPrimary liver cell carcinoma (PLCC), predominantly hepatocellular carcinoma is a killer. In the southwestern region of Nigeria it occupies the second position, behind prostate cancer in males. Females account for about a third of diagnosed cases. Children are not spared. Over 80 % of PLCC cases present to the hospital at an advanced stage in Nigeria and some die within weeks of admission to the wards. A prospective hospital based study was carried out to determine muco-cutaneoeus features associated with the entity as a possible aid to diagnosis cutaneous features being considered a cheap tool that can help diagnosis in a developing country-at an affordable cost. 80 of 84 patients seen during the study period had data that were adequate for analysis. The age range was 18-76 years with a mean of 56.2 years. The male female ratio was 17:3 indicating that males remain the more affected gender. No skin feature was found to be specific to PLCC. Jaundice (63.75 %), pallor 43.75 %), peripheral oedema (32.50 %), palmoplantar macular hyperpigmentation (47.5 %/25.0% -plantar /palmar) however were the common features documented in the study. Moderate to severe pityriasis versicolor was found in 18.75 % of cases. 61.25 % had core temperature less than 36 0 C. Amongst non-cutaneous features found on examination, right sided upper abdominal pain/discomfort and swelling were common. While none of the features documented in this study are specific to PLCC (and most are likely related to underlying liver cirrhosis) it may be helpful to realize that Jaundice and marked palmoplantar macular pigmentation, the complaint of pain /mass, and the presence of a tender nodular mass in the right hypochondrium should make one to consider the localization of the disease to the liver. Pain/tenderness in the right hypochondrium suggest rapid growth of the liver from increased mitosis in the hepatocytes and a stretching of the liver capsule. Metastasis to the liver accounts for a very small percentage in Nigerians. A nodular liver is thus likely to be from a primary liver pathology.

Paraneoplastic Cutaneous Manifestations of Hepatocellular Carcinoma. A Systematic Review and Meta-analysis

“…In these syndromes, patients present with skin abnormalities secondary to the systemic effect of neoplastic cells, which are not related to the underlying liver disease, distant metastasis, or treatment side effects. Previous studies emphasized that paraneoplastic cutaneous manifestations of HCC are more commonly detected in males and in cirrhotic patients 7 , 12 . Other studies indicated associations with particular cutaneous abnormalities and some underlying liver diseases 7 .…”