Subacute cutaneous lupus erythematosus with a possible paraneoplastic association with melanoma

Abstract

A 52-year-old man was referred to our dermatology clinic for a diagnosis of melanoma. At the time, his melanoma was excised he developed an annular, polycyclic, scaling eruption consistent with subacute cutaneous lupus erythematosus (SCLE). Skin biopsy and laboratory evaluation confirmed this diagnosis. The patient had been using pantoprazole for gastro-oesophageal reflux disease for the last 3 years. The patient's melanoma was treated surgically, and his SCLE was treated with topical steroids and hydroxychloroquine. His SCLE cleared rapidly, his steroids and hydroxychloroquine were stopped and he remains free of SCLE off of treatment. The parallel course of the patient's SCLE and melanoma prompted consideration of SCLE as paraneoplastic to melanoma in this case. The clinical picture was complicated by the patient's use of a proton pump inhibitor, which are common causes of drug-induced SCLE. To our knowledge, this is the first reported case of possible paraneoplastic SCLE associated with melanoma.

Keywords: dermatology; drugs and medicines; oncology; rheumatology.

Figure 1

Annular, polycyclic erythematous plaques on the patient’s back.

Figure 2

Note the koebnerization around the patient’s melanoma excision scar.

Figure 3

An “ugly duckling” deep brown papule on the patient’s right shoulder. An atypical pigment network was seen on dermoscopy. The patient’s rash can also be seen.

Figure 4

Histopathology of the patient’s rash, which demonstrates interface dermatitis with basovacuolar degeneration, necrotic keratinocytes, a perivascular lymphocytic infiltrate and abundant mucin deposition.

Figure 5

Pathology from the melanocytic lesion shown in figure 3. There is cellular atypia, bridging of the rete ridges, pagetoid scatter, an atypical dermal component and a brisk lymphocytic infiltrate. Tumour depth was 0.4 mm.