Evaluation of dermatological findings in patients with gastrointestinal malignancy

Objectives: Although the incidence of gastrointestinal malignancies is increasing, this patient group represents a sensitive population due to both the disease itself and its treatments. In addition to paraneoplastic skin findings that may lead to early diagnosis, skin diseases with an increased frequency due to immunosuppression and cutaneous side effects secondary to chemotherapy are frequently encountered in dermatology clinics. The aim of this study is to raise awareness in terms of early diagnosis, treatment management and what can be done in the dermatologically for patient comfort in this patient group whose incidence is increasing in the society. Methods: Our study was carried out jointly by Karadeniz Technical University Faculty of Medicine, Department of Dermatology, Department of Medical Oncology and Department of General Surgery. 150 patients with clinical and histopathological diagnosis of gastrointestinal system malignancy who applied to dermatology, medical oncology and general surgery outpatient clinics between April 2021 and April 2022 were included in the study. Sociodemographic characteristics, habits, comorbidities and primary malignancy-related features of all patients included in the study were recorded in detail. A detailed whole body dermatological examination of all individuals was performed at the time of admission included in the study. A standardized form was prepared and the information and findings of each case were recorded. In addition to detailed dermatological examination findings, paraneoplastic skin findings and findings that could be associated with chemotherapy agents were also noted. Results: Of the patients included in our study, 96 (64%) were male, 54 (36%) were female, with a mean age of 62.47 (±10.7) years. The Fitzpatrick skin types of the patients were, in order of frequency, type 3 (42.7%), 4 (29.3%), 2 (26.7%), and 5 (1.3%). The mean body mass index (BMI) was 25.86 (±5.7). The most common primary malignancies were colon (32.7%), stomach (32%) and rectum (16.7%), and the most common histological subtype was adenocarcinoma (93.3%). The mean disease duration was 12.72 (±20.5) months, considering the time they were included in the study from the date of diagnosis. 80.7% of those included in the study had advanced disease (stages 3 and 4). At the time of examination, 85 (56.7%) of the patients were under chemotherapy regimen. The most common dermatological finding in our patients was xerosis (92%), and it was found to be statistically significantly higher in patients over the mean age of 62 years (p=0.014). In our study, paraneoplastic dermatoses, facial findings, nail findings and skin infections were found to be significantly higher in patients over the mean age of 62 years (p=0.008, p=0.003 and p=0.007, respectively). When considered according to gender, facial findings and skin infections were more frequently seen in female patients than in males, the difference was statistically significant (p=0.04 and p=0.04, respectively). In our study, the most common paraneoplastic skin finding was eruptive seborrheic keratosis (20.7%), and acanthosis nigricans (10.7%) was the second most common. Seborrheic keratosis was observed more frequently in patients with a mean BMI of less than 28.5, and acanthosis nigricans was more common in patients with a mean BMI of above 28.5, a statistically significant difference was found (p=0.04 and p<0.001, respectively). Seborrheic keratosis was observed more frequently in patients and men over the mean age of 62 years, and the difference was statistically significant (p=0.003 and p=0.01, respectively). In our study, the most common hair finding was androgenetic alopecia (58.7%), facial finding was rosacea (38.7%), nail finding was longitudinal groove (20.7%), skin infection was tinea unguium (68.7%), oral mucosa finding was oral candidiasis (34.7%). In our study, the most frequently used chemotherapy agent was 5-fluorouracil, and oxaliplatin was the second most common in 85 patients under chemotherapy. At least one of the chemotherapy-related dermatological findings was present in 69.4% of the patients under treatment. 5-fluorouracil, oxaliplatin, irinotecan were the most common treatment regimens of patients with chemotherapy-related dermatological findings. Considering the chemotherapy-related dermatological findings; the most common ones were chemotherapy-related pigmented macules (25.9%) and hair loss (25.9%), which were encountered with equal frequency, while papulopustular rash (18.8%) was the second most common. Conclusion: In our study, the most common paraneoplastic skin diseases seen in patients with gastrointestinal malignancies were eruptive seborrheic keratosis and acanthosis nigricans. This frequency was found to be higher in older age and male patients for seborrheic keratosis and in obese patients for acanthosis nigricans. 5-fluorouracil and oxaliplatin agents were found to be more risky in terms of chemotherapy-related dermatological findings. We think that the data of our prospective study will contribute to the early diagnosis and correct management of patients by revealing the common dermatological findings in patients with gastrointestinal malignancies.