IntroductionThe appearance of certain dermatoses has heralded either the diagnosis of a previously unsuspected malignancy or the detection of cancer recurrence in an oncology patient. 1,2 These associated mucosal and cutaneous conditions are referred to as mucocutaneous paraneoplastic syndromes. 3 In this issue, Zappasodi et al . 4 review some of the mucocutaneous paraneoplastic syndromes that occur in patients with hematologic malignancies. Albeit less commonly, other dermatologic conditions and systemic disorders can also occur in a paraneoplastic setting associated with hematologic malignancies: granuloma annulare, relapsing polychondritis, sarcoidosis, and systemic lupus erythematosus.
Granuloma AnnulareGranuloma annulare is a chronic dermatosis of undetermined etiology. Clinically, the skin lesions present as flesh-colored to red papules and small nodules, which appear either as individual lesions or as an annular arrangement of confluent lesions. Mucin-containing areas of necrobiotic collagen in the dermis are surrounded by palisading granulomas consisting of epithelioid histiocytes, lymphocytes, and multinucleated giant cells.Granuloma annulare can be localized to a specific area of the body or generalized. Perforating and subcutaneous variants of the condition may also occur. Several factors have been described to precipitate the development of granuloma annulare: sunburn, drug eruption, flu-like illness, trauma, insect bites, and acute phlebitis. In addition, granuloma annulare has been observed in patients with potentially associated diseases -particularly diabetes mellitus and thyroid disease, but also drug allergy, hypertension, obesity, arthritis, atopy, sarcoidosis, and human immunodeficiency virus infection. [5][6][7][8][9] Skin lesions of leukemia or lymphoma that histopathologically mimic granuloma annulare have also been described in patients with hematologic malignancies. 10-14 Cancer-associated granuloma annulare has been reported predominantly in patients with hematologic malignancies (most commonly non-Hodgkin's lymphoma and Hodgkin's disease) and, less often, in individuals with solid tumors (Table 1). 5,6,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]
Relapsing PolychondritisRelapsing polychondritis is a multisystemic disorder characterized by recurrent inflammation and degeneration of cartilaginous tissues -particularly those of the ears, nose, larynx, and trachea. [34][35][36][37] The dermatologic manifestations of relapsing polychondritis are variable and include aphthosis [oral and complex (genital)], nodules (on the extremities), purpura, papules, sterile pustules, superficial phlebitis, livedo reticularis, ulcers (on the extremities), and distal necrosis. 38 The aorta, bone, bronchi, central nervous system, ears, eyes, genitals, heart valves, kidneys, larynx, mouth, nose, and trachea are potential sites of extracutaneous involvement in patients with relapsing polychondritis. 34,38,39 The diagnostic criteria for relapsing polychondritis were initially e...