Florid Cutaneous Papillomatosis Clinical Presentation

Updated: Apr 16, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

The patient usually reports an eruption of wartlike growths. Unusually marked verrucous changes may cause disfigurement of the hands and feet. [15, 16]

Pruritus is an important sign that is evident in about one half of patients. Pruritus may precede the onset of florid cutaneous papillomatosis. It can occur in the affected regions, or it can be generalized.

The unsightly clinical appearance of florid cutaneous papillomatosis may result in social exclusion. [17]

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Physical Examination

Clinically, the papulonodules of florid cutaneous papillomatosis are usually indistinguishable from common viral warts. The papulonodules begin on the extremities, particularly on the dorsa of the hands and the wrists. The papules may spread to involve the entire body, including the face. The papulonodules can be as large as 1 cm in diameter, or they can be as small as 2-3 mm in diameter. Pruritus may be associated. The esophagus may be involved. [18]

Florid cutaneous papillomatosis is usually associated with signs of internal cancer. [13] Malignant acanthosis nigricans develops eventually, many times with the sign of Leser-Trélat. Marked acanthosis nigricans, especially when associated with either florid cutaneous papillomatosis or so-called tripe palms, mandates a thorough search for malignancy. [19, 20, 21, 22, 23, 24] Florid cutaneous papillomatosis may be seen in patients with multiple visceral carcinomas [25] or with an adenocarcinoma of unknown primary site. [26]

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