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Paraneoplastic Syndromes, Cutaneous 756.e3

• Exfoliative dermatosis resolution of the cutaneous lesions ultimately Technician Tips
○ Dermatohistopathologic exam: cell-poor depends on control or resolution of the Palliative therapy and hospice care, in hospital
VetBooks.ir keratinocytes in the stratum basal and for dermatologic lesions should be provided. satisfactory quality of life for many of these Diseases and Disorders
interface dermatitis with apoptotic
and at home, may be necessary to maintain a
underlying internal neoplasm. Palliative care
stratum spinosum layers
patients.
Acute General Treatment
○ Thoracic radiographs/ultrasound: medi-
astinal mass • Paraneoplastic alopecia: surgical excision of SUGGESTED READING
• Nodular dermatofibrosis neoplasm, if possible Outerbridge CA: Cutaneous manifestations of internal
○ Dermatohistopathologic exam: nodular • Exfoliative dermatosis: surgical excision of diseases. Vet Clin North Am Small Anim Pract
areas of collagenous hyperplasia (col- thymoma 43(1):135-152, 2013.
lagenous nevi) • Nodular dermatofibrosis: unilateral nephrec-
○ Abdominal imaging: renal cysts, renal tomy is indicated if renal cysts are severe; ADDITIONAL SUGGESTED
masses (neoplasms), or uterine masses bilateral renal disease is common. READINGS
(neoplasms) • Paraneoplastic pemphigus: none reported Caporali C, et al: Two cases of feline paraneoplastic
• Paraneoplastic pemphigus alopecia associated with a neuroendocrine pancreatic
○ Dermatohistopathologic exam: intraepider- Chronic Treatment neoplasia and a hepatosplenic plasma cell tumour.
mal acantholysis, apoptotic keratinocytes, • Nodular dermatofibrosis: benign neglect or Vet Dermatol 27:508-512, 2016.
vacuolar interface dermatitis, suprabasilar surgical excision of collagenous nevi until Hill PB, et al: Putative paraneoplastic pemphigus
clefting end-stage renal failure develops and myasthenia gravis in a cat with a lymphocytic
○ Abdominal and thoracic imaging: masses ○ Address chronic kidney disease as necessary thymoma. Vet Dermatol 24;646-649, 2013.
(primary neoplasm, metastases) (p. 169). Lemmens P, et al: Paraneoplastic pemphigus in a
dog. Vet Dermatol 9:127-134, 1998.
Advanced or Confirmatory Testing PROGNOSIS & OUTCOME Matousek JL: Paraneoplastic skin diseases. In Camp-
bell KL, editor: Small animal dermatology secrets,
• Paraneoplastic alopecia Philadelphia, 2004, Hanley & Belfus, pp 300-304.
○ Exploratory laparotomy with pancreatic, • Paraneoplastic alopecia: grave; euthanasia Miller WH Jr, et al: Muller & Kirk’s Small animal
liver, or biliary tract biopsies due to advanced disease dermatology, ed 7, St. Louis, 2013, Saunders.
• Exfoliative dermatosis • Exfoliative dermatosis: guarded; outcome Turek ME: Cutaneous paraneoplastic syndromes
○ Fine-needle aspiration of the mediastinal depends on complete thymoma removal in dogs and cats: a review of the literature. Vet
mass and cytologic exam • Nodular dermatofibrosis: poor for long-term Dermatol 14:279-296, 2003.
○ Core biopsies of the mediastinal mass survival; slowly progressive kidney disease;
• Nodular dermatofibrosis average life span is 9 years RELATED CLIENT EDUCATION
○ Biopsy of renal masses • Paraneoplastic pemphigus: grave unless SHEETS
• Paraneoplastic pemphigus neoplasm can be removed; euthanasia for
○ Biopsy of tumor failure to respond to immunosuppression Consent to Perform Abdominal Ultrasound
○ Indirect immunofluorescence testing: Consent to Perform Fine-Needle Aspiration
positive on stratified and nonstratified PEARLS & CONSIDERATIONS of Masses
squamous epithelia
○ Western blot analysis; target antigen Comments AUTHOR: Stephanie R. Bruner, DVM, DACVD
EDITOR: Manon Paradis, DMV, MVSc, DACVD
proteins include envoplakin (210 kD), • Cutaneous clinical signs represent the tip of
periplakin (190 kD), desmoglein III the iceberg.
(130 kD), and an unidentified antigen • Internal disease is often advanced at the time
(170 kD) of presentation.
• Earlier recognition may improve outcome
TREATMENT in some cases (at least in thymoma).
• Nodular dermatofibrosis may precede clinical
Treatment Overview signs of renal disease by 3-5 years and does
The goal of treatment is to resolve the primary not warrant immediate consideration of
neoplasm if possible because control or euthanasia.

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