Mindful Zebra: My Skin Is Telling Me What?

Hey, good looking, have you been noticing subtle changes with your skin? You might want to get your cute booty to the skin doctor ASAP. Patients living with neuroendocrine cancers including carcinoid are frequently familiar with two of the classic symptoms of the disease including flushing and diarrhea. Subtle, often unrecognized symptoms that are often associated with isolated benign diseases can sometimes run concurrent with patients living with neuroendocrine and carcinoid syndrome. In an article published in the NEJM Watch, Dr. Jeffrey P. Callen, reviewing an earlier study by H.K. Bell, states that often times these skin conditions, if accompanied by other systemic symptoms, could be helpful in earlier diagnosis of the disease and progression.

This study was carried out with 25 patients who all had metastatic neuroendocrine cancer. All experienced flushing with the exception of one. Patients of a multidisciplinary clinic for neuroendocrine tumors were invited to participate in a 23-month period between February 2001 and December 2002. This study included completion of a standardized medical history form, and each patient had a detailed skin exam with findings recorded by clinical photography. What researchers discovered was that certain skin conditions were not uncommon concurrent with carcinoid syndrome. These skin conditions are readily diagnosed on clinical examination, and may be useful indicators of disease activity and prognosis. Many of the patients reported having these skin conditions prior to their diagnosis of neuroendocrine cancer.

Skin symptoms were the initial presentation in many of these patients. Careful attention to such symptoms in patients presenting to dermatology offices and clinics might promote earlier diagnosis of malignant carcinoid tumors.

A list of the conditions that patients in the study presented with include:

  • Flushing (these are dry flushing symptoms)
  • Rosacea (redness of the skin)
  • Early Rhinophyma (Bulbous thickening of the nose)
  • Pellagra-like changes often on acral skin (scaly sores on palms of hands and soles of feet)
  • Scleroderma (hardening of skin and connective tissues)
  • Xerosis (abnormal dryness)
  • Skin Nodules (which could be metastatic)
  • Lichen Planus (itchy, purplish flat-top bumps)

Anecdotally, many patients in our groups have mentioned having various skin conditions prior to their diagnosis. As this is a rare cancer, there is little available data on these types of subtle, varied conditions and should always be discussed with your doctors. If you are noticing little changes in your skin, especially with other systemic conditions of diarrhea or other GI symptoms, it might be time to visit your dermatologist and your doctor or specialist. Your skin is the outer layer of your beautiful self. By taking care of the outside, we are also taking care of our insides, too.