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The necrolytic erythemas is a group of disorders with similar histologic and clinical features. The objective of this case report is to present a patient with features of both necrolytic migratory erythema (NME) and necrolytic acral erythema (NAE). These 2 entities appear more likely to be on a spectrum caused by the same underlying process of abnormal liver function and glucagon metabolism.

Necrolytic migratory erythema (NME) is a skin condition historically associated with pancreatic glucagonomas. Rarely it occurs in the absence of a pancreatic tumor, which has been described as pseudoglucagonoma syndrome. We describe a woman with a metastatic neuroendocrine tumor who developed NME 6 years after diagnosis of the tumor. Her laboratory data revealed essential fatty acid deficiency and a high level of glucagon. Although the pathogenesis of NME is not completely understood, zinc, essential amino acid, and fatty acid deficiencies have all been postulated as possible causative factors.