Acrokeratosis Paraneoplastica Workup

Updated: Nov 05, 2021
  • Author: Katherine R Garrity, MD; Chief Editor: William D James, MD  more...
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Laboratory Studies

Skin biopsy and potassium hydroxide (KOH) examination should be performed, as should a CBC count and liver function profile.

Other tests are guided by findings from a complete history and physical examination [13] and may include the following:

  • Serum tumor markers (ie, prostate-specific antigen, carcinoembryonic antigen)

  • Serum and urine protein electrophoresis

  • Creatinine, BUN, and electrolyte values

  • Urinalysis

  • Erythrocyte sedimentation rate (ESR)

  • Stool guaiac


Imaging Studies

Chest radiography should be performed in all patients suspected of having acrokeratosis paraneoplastica. [13] Other radiological examinations to be considered based on the history and physical examination findings include the following:

  • CT scanning of the head/neck, chest, and abdomen

  • MRI of the head/neck, chest, and abdomen

  • Abdominal or pelvic ultrasonography

  • Mammography

  • Positron emission tomography scanning


Other Tests

Other tests should be guided by the history, physical examination, imaging, and laboratory findings. These may include the following [13] :

  • Upper GI endoscopy

  • Bronchoscopy

  • Lymph node biopsy

  • Bone marrow biopsy

  • Cystoscopy


Histologic Findings

Skin biopsy specimens in acrokeratosis paraneoplastica often reveal nonspecific findings. In one review of 80 acrokeratosis paraneoplastica skin biopsy specimens, the most common histologic findings were hyperkeratosis, acanthosis, parakeratosis, and a perivascular infiltrate of lymphocytes and histiocytes. Dyskeratotic keratinocytes, vacuolar degeneration, and pigment incontinence were also occasionally seen. Other reported findings in acrokeratosis paraneoplastica lesions include spongiosis, exocytosis, lichenoid inflammation, and telangiectasias. [12, 22]  Note the images below.

At this power, a patchy lichenoid infiltrate of pr At this power, a patchy lichenoid infiltrate of predominantly lymphocytes can be seen underneath an epidermis with psoriasiform hyperplasia and serum crust in the parakeratotic cornified layer (hematoxylin and eosin, 100X).
Focal vacuolar interface change is seen with assoc Focal vacuolar interface change is seen with associated pigment incontinence and exocytosis of lymphocytes (hematoxylin and eosin, 200X).

In acrokeratosis paraneoplastica cases in which immunofluorescence is performed, localized deposits of immunoglobulins, C3, or fibrin may be seen within the basement membrane. [23]