Florid Cutaneous Papillomatosis 

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 13, 2011
 

Background

Florid cutaneous papillomatosis (FCP) is a disorder consisting of the rapid onset of numerous warty papules on the trunk and the extremities that are clinically indistinguishable from viral warts.[1, 2] It was first observed in 1891.[3] Florid cutaneous papillomatosis was first described and the name florid cutaneous papillomatosis was coined in 1978 by Schwartz and Burgess.[4]

Florid cutaneous papillomatosis usually occurs in association with malignant acanthosis nigricans and an internal malignancy (see Acanthosis Nigricans). In fact, florid cutaneous papillomatosis is believed to be an obligatory paraneoplastic syndrome in that it has always been associated with an internal malignancy (see Paraneoplastic Diseases and Paraneoplastic Syndromes). The cancer, which is usually intra-abdominal and most often gastric in origin, tends to evolve in parallel with florid cutaneous papillomatosis. The onset of florid cutaneous papillomatosis often becomes evident before or concurrent with the diagnosis of the internal tumor.

In a review of 46 patients, Stieler and Plewig[5] noted that each patient had an underlying cancer. The most common type was gastric adenocarcinoma, which occurred in more than half the patients. One patient had a gastric adenocarcinoma and a second malignancy, namely, breast adenocarcinoma. Other neoplasms that are reported to occur with florid cutaneous papillomatosis include other intra-abdominal tumors, such as cancer of the urinary bladder, biliary ducts, ovaries, and uterus; breast adenocarcinoma; squamous cell carcinoma of the lungs; and non-Hodgkin lymphoma.

Florid cutaneous papillomatosis occurs with signs of internal cancer. Although acanthosis nigricans and the sign of Leser-Trélat (ie, eruptive seborrheic keratoses) are most frequently linked to florid cutaneous papillomatosis, other signs, such as hypertrichosis lanuginosa acquisita, can be present.[6] See Sign of Leser-Trelat for more information on this topic.

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Pathophysiology

The etiology of florid cutaneous papillomatosis is not known, as is the cause of the other 2 eruptive paraneoplastic syndromes that occur with florid cutaneous papillomatosis: malignant acanthosis nigricans and the sign of Leser-Trélat. These 3 paraneoplastic syndromes are probably directly induced by their underlying neoplasms, most likely by means of a tumor-secreted growth factor.[1]

In 1976, Millard and Gould[7] found high levels of immunoreactive human growth hormone in 2 patients with tylosis, one of whom had the sign of Leser-Trélat. In another report, a patient was described as having a small cutaneous melanoma, acanthosis nigricans, the sign of Leser-Trélat, and multiple acrochordons. In this patient, the lesions of the cutaneous paraneoplastic syndrome were stimulated by the epidermal growth factor receptor.[8] Increased epidermal staining for the epidermal growth factor receptor was initially noted in skin specimens of acanthosis nigricans, seborrheic keratoses, and cutaneous papillomas. Both the staining and the urine level of alpha-transforming growth factor markedly decreased after the primary nonmetastatic melanoma was removed. Alpha-transforming growth factor is structurally related to epidermal growth factor but antigenically distinct from it.

Florid cutaneous papillomatosis, malignant acanthosis nigricans, and the sign of Leser-Trélat should be viewed as part of a continuum. These conditions develop by means of a common or similar pathogenic pathway due to an underlying malignancy that produces a factor possibly similar to human epidermal growth factor.

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Epidemiology

Frequency

United States

Florid cutaneous papillomatosis is a rare disease. So far, only about 25 patients have been reported. Pollitzer[3] described the first case in 1891.

Sex

From the limited number of patients described to date, florid cutaneous papillomatosis is almost twice as common in men than in women.

Age

Florid cutaneous papillomatosis is usually diagnosed in individuals aged 53-72 years (mean patient age, 58.5 y).

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Takeji Nishikawa, MD  Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Schwartz RA. Florid cutaneous papillomatosis. Clin Dermatol. Jan-Mar 1993;11(1):89-91. [Medline].

  2. Janniger EJ, Schwartz RA. Florid cutaneous papillomatosis. J Surg Oncol. Nov 1 2010;102(6):709-12. [Medline].

  3. Pollitzer S. Unna PG, Morris M, Leloir H, Duhring LA, eds. International Atlas of Rare Skin Diseases. London, England: HK Lewis; 1891:1-3.

  4. Schwartz RA, Burgess GH. Florid cutaneous papillomatosis. Arch Dermatol. Dec 1978;114(12):1803-6. [Medline].

  5. Stieler W, Plewig G. [Acanthosis nigricans maligna and Leser-Trelat sign in double malignancy of the breast and stomach]. Z Hautkr. Mar 1 1987;62(5):344-66. [Medline].

  6. Dingley ER, Marten RH. Adenocarcinoma of the ovary presenting as acanthosis nigricans. J Obstet Gynaecol Br Emp. Dec 1957;64(6):898-900. [Medline].

  7. Millard LG, Gould DJ. Hyperkeratosis of the palms and soles associated with internal malignancy and elevated levels of immunoreactive human growth hormone. Clin Exp Dermatol. Dec 1976;1(4):363-8. [Medline].

  8. Ellis DL, Kafka SP, Chow JC, et al. Melanoma, growth factors, acanthosis nigricans, the sign of Leser-Trélat, and multiple acrochordons. A possible role for alpha-transforming growth factor in cutaneous paraneoplastic syndromes. N Engl J Med. Dec 17 1987;317(25):1582-7. [Medline].

  9. Singhi MK, Gupta LK, Bansal M, Jain V, Kachhawa D. Florid cutaneous papillomatosis with adenocarcinoma of stomach in a 35 year old male. Indian J Dermatol Venereol Leprol. May-Jun 2005;71(3):195-6. [Medline].

  10. Csete B, Moezzi M, Lengyel Z, Hodosi B, Zombai E, Battyani Z. Florid cutaneous papillomatosis leading to social exclusion. Br J Dermatol. Sep 2005;153(3):667-9. [Medline].

  11. Kleikamp S, Bohm M, Frosch P, Brinkmeier T. [Acanthosis nigricans, papillomatosis mucosae and "tripe palms" in a patient with metastasized gastric carcinoma]. Dtsch Med Wochenschr. May 26 2006;131(21):1209-13. [Medline].

  12. Bottoni U, Dianzani C, Pranteda G, et al. Florid cutaneous and mucosal papillomatosis with acanthosis nigricans revealing a primary lung cancer. J Eur Acad Dermatol Venereol. May 2000;14(3):205-8. [Medline].

  13. Jung DS, Oh CK, Lee JB, Kim MB, Jang HS, Kwon KS. Three Cases of Cutaneous Paraneoplastic Syndromes: Coexistence of Acanthosis Nigricans, Tripe Palms and Cutaneous Florid Papillomatosis. Korean J Dermatol. 2003;41:1364-1369. [Full Text].

  14. Noh Y, Lee GC, Kim MK, Kim YS, Yoon TY. A Case of Florid Cutaneous Papillomatosis and Tripe Palm. Korean J Dermatol. 2002;40:860-862. [Full Text].

  15. Weger W, Ginter-Hanselmayer G, Hammer HF, Hodl S. Florid cutaneous papillomatosis with acanthosis nigricans in a patient with carcinomas of the lung and prostate. J Am Acad Dermatol. Nov 2007;57(5):907-8. [Medline].

  16. Yoo KH, Rho YK, Kim JY, Li K, Seo SJ, Hong CK. Cutaneous paraneoplastic syndrome in a patient with adenocarcinoma of unknown primary site syndrome. J Clin Oncol. Jan 10 2009;27(2):309-11. [Medline].

  17. Pentenero M, Carrozzo M, Pagano M, Gandolfo S. Oral acanthosis nigricans, tripe palms and sign of leser-trélat in a patient with gastric adenocarcinoma. Int J Dermatol. Jul 2004;43(7):530-2. [Medline].

  18. Tuveri M, Calò PG, Mocci C, Nicolosi A. Florid papillomatosis of the male nipple. Am J Surg. Apr 19 2010;[Medline].

  19. Jablonska S, Kozminska A, Chorzelski T. [An unusual variant of acanthosis nigricans. (Relations of acanthosis nigricans to generalized verrucosis)]. Dermatol Wochenschr. Feb 13 1965;151:177-85. [Medline].

  20. Nomachi K, Mori M, Matsuda N. Improvement of oral lesions associated with malignant acanthosis nigricans after treatment of lung cancer. Oral Surg Oral Med Oral Pathol. Jul 1989;68(1):74-9. [Medline].

  21. Nomura J, Tagawa T. Acanthosis nigricans with oral lesions and a malignant visceral tumor: a case report. J Oral Maxillofac Surg. Feb 1992;50(2):169-72. [Medline].

  22. Abeloff MD. Paraneoplastic syndromes: a window on the biology of cancer. N Engl J Med. Dec 17 1987;317(25):1598-600. [Medline].

  23. Achten G, Ledoux-Corbusier M, Goens J. [Classification and pathogenesis of cutaneous paraneoplastic syndromes]. Ann Med Interne (Paris). 1984;135(8):646-53. [Medline].

  24. Andreev VC, Boyanov L, Tsankov N. Generalized acanthosis nigricans. Dermatologica. 1981;163(1):19-24. [Medline].

  25. Clarke J. Malignant acanthosis nigricans. Clin Exp Dermatol. Jun 1977;2(2):167-70. [Medline].

  26. De Backer J, Kint A. Malignant acanthosis nigricans with multiple verrucous formations. Arch Belg Dermatol Syphiligr. Jul-Sep 1971;27(3):317-22. [Medline].

  27. Forman L. Acanthosis nigricans with discrete warts and marked mucous membrane changes in a patient with vitiligo. Proc Royal Soc Med. 1943;36:611.

  28. Gheeraert P, Goens J, Schwartz RA, Lambert WC, Schroeder F, Debusscher L. Florid cutaneous papillomatosis, malignant acanthosis nigricans, and pulmonary squamous cell carcinoma. Int J Dermatol. Mar 1991;30(3):193-7. [Medline].

  29. Gross G, Pfister H, Hellenthal B, Hagedorn M. Acanthosis nigricans maligna. Clinical and virological investigations. Dermatologica. 1984;168(6):265-72. [Medline].

  30. Hage E, Hage J. Malignant acanthosis nigricans--a para-endocrine syndrome?. Acta Derm Venereol. 1977;57(2):169-72. [Medline].

  31. Jablonska S. [Acanthosis nigricans a sign of malignant cancer proliferation of internal organs]. Pol Tyg Lek. Sep 6 1965;20(36):1355-7. [Medline].

  32. Janier M, Blanchet-Bardon C, Bonvalet D, Lenoble M, Boiget F, Civatte J. Malignant acanthosis nigricans associated with non-Hodgkin's lymphoma. Report of 2 cases. Dermatologica. 1988;176(3):133-7. [Medline].

  33. Knapp A. [Pathogenesis of acanthosis nigricans.]. Dermatol Wochenschr. Mar 30 1957;135(13):313-27. [Medline].

  34. Lenzner U, Ramsauer J, Petzoldt W, Meigel W. [Acanthosis nigricans maligna. Case report and review of the literature]. Hautarzt. Jan 1998;49(1):41-7. [Medline].

  35. Milian G, Perin L, Babalian D. Condylomatose acuminee en nappe et acanthosis nigricans. Bull Soc Fr Dermatol Syoh. 1934;41:1914-6.

  36. Misch KJ, Griffiths WA, Eady RA. Warts as a presenting sign in acanthosis nigricans. Clin Exp Dermatol. Nov 1983;8(6):651-6. [Medline].

  37. Navaratnam A, Hodgson GA. Acanthosis nigricans with carcinoma of the stomach. Brit J Dermatol. 1973;89:46-50.

  38. Schwartz RA. Acanthosis nigricans, florid cutaneous papillomatosis and the sign of Leser-Trèlat. Cutis. Sep 1981;28(3):319-22, 326-7, 330-1 passim. [Medline].

  39. Schwartz RA. Clinical Dermatology. 18th ed. New York, NY: Harper & Row; 1991:1-3.

  40. Sneddon IB, Roberts JB. An incomplete from of acanthosis nigricans. Gut. Sep 1962;3:269-72. [Medline].

  41. Weger W, Ginter-Hanselmayer G, Hammer HF, Hodl S. Florid cutaneous papillomatosis with acanthosis nigricans in a patient with carcinomas of the lung and prostate. J Am Acad Dermatol. Nov 2007;57(5):907-8. [Medline].

  42. White H. Acanthosis nigricans and wart-like lesions associated with metastatic carcinoma of the stomach. Cutis. May 1976;17(5):931-3. [Medline].

  43. Worret WI, Mayerhausen W, Emslander HP. Hypertrichosis lanuginosa acquista associated with florid cutaneous papillomatosis. Int J Dermatol. Jan 1993;32(1):56-8. [Medline].

  44. Yeh JS, Munn SE, Plunkett TA, Harper PG, Hopster DJ, du Vivier AW. Coexistence of acanthosis nigricans and the sign of Leser-Trelat in a patient with gastric adenocarcinoma: a case report and literature review. J Am Acad Dermatol. Feb 2000;42(2 Pt 2):357-62. [Medline].

 
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