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Docetaxel is a commonly used chemotherapeutic agent and can cause skin side effects including hand-foot syndrome. Hand-foot syndrome is mostly limited to palmoplantar regions, but may sometimes require discontinuation of the drug because of the severity of the lesions. In this report, we present three patients admitted to our dermatovenereology department for the lesions at the dorsal side of the hand, an unusual location for this side effect, while receiving docetaxel treatment in the oncology clinic. Erythematous, scaly patches on the dorsum of the hands were the common feature in the three patients. There were accompanying plantar involvement in one of the patients, and nail findings (onycholysis, melanonychia striata) in the other two patients. Premedication with corticosteroid before chemotherapy in these patients could not prevent the dermatologic side effects. The lesions healed after discontinuation of docetaxel and use of symptomatic topical drugs. The cutaneous side effects of docetaxel may reduce the quality of life and even lead to discontinuation of the drug as seen in our cases. The occurrence of lesions on both hand dorsums in our patients suggests that hand-foot syndrome induced by docetaxel is not always limited to palmoplantar regions.

There are various types of benign skin tumors in association with the complex nature of the skin. A minor part of them may be associated with visceral malignancies. This review focuses on the benign skin tumors that are described to have well-known associations with systemic malignancies or those with controversial associations. These tumors and the associated conditions are as follows: seborrheic keratosis/ Leser-Trélat sign, lentigo simplex/Peutz Jeghers and Carney syndrome, sebaceous tumors/ Muir-Torre syndrome, fibrofolliculoma- trichodiskoma/ Birt-Hogg-Dubé syndrome, trichoepitheliomacylindroma- spiradenoma/ Brooke-Spiegler syndrome, leiomyoma/multiple cutaneous and uterin leiomyomatosis syndrome, glomeruloid hemangioma/ POEMS syndrome, venous malformation/ Maffucci syndrome, mucosal neuroma/ multiple endocrine neoplasia type 2B, juvenile xanthogranuloma/ juvenile chronic myeloid leukemia. It is important to know the skin tumors related with visceral malignancies in part of a syndrome or in association with a sign as this may yield an earlier recognition of these malignancies.

Although most of the keratinization disorders are congenital diseases, there are also acquired forms of keratinization disorders. Among their multiple causes systemic malignancies deserve special attention. Acquired ichthyosis, Bazex syndrome and tripe palms are among diseases with highest ratio of paraneoplastic association. On the other hand, acanthosis nigricans has very severe and atypical presentations when associated with malignancy. Acquired palmoplantar keratoderma without any detectable cause could rarely have paraneoplastic origin. The early and correct diagnosis of these diseases is important to disclose the malignancies early.

Lymphoepithelioma-like carcinoma can be originated from different organs, including nasopharynx, larynx, stomach, salivary glands, lung, thymus, cervix and bladder. Lymphoepithelioma-like carcinoma of the skin is a rare malignancy with low metastatic potential and is defined by a histologic picture simulating indifferentiated nasopharynx carcinoma. There are only a few case reports in the literature and the clinical features of the tumor are not well described. It presents usually with flesh-colored or reddish firm nodules and plaques which are nonspecific. The head and neck region is the predilection site of the tumor, but it can be seen in many other areas. We present here an 84-year-old male admitted to the dermatovenereology department with a slowly growing purplish-red asymptomatic plaque, 2x2 cm in diameter which was diagnosed as lymphoepithelioma-like carcinoma of the skin upon histopathologic examination. The tumor was excised and metastasis was not detected. Local recurrence was not observed in a one-year follow-up period. Lymphoepithelioma-like carcinoma of the skin should also be considered in the clinical differential diagnosis of slowly growing solitary nodules and infiltrated plaques. An other important feature of our case was the arm localization of the tumor which has been very rarely reported.

Background and Design: Epidermal growth factor receptor (EGFR) inhibitors may cause different adverse cutaneous reactions including acneiform (pustular, papulopustular) eruption. Rarely, other specific targeted cancer therapy agents may cause similar pustular eruptions. The aim of this study was to evaluate the adverse skin reactions, mainly acneiform eruptions caused by these chemotherapeutic agents. Material and Methods: We retrospectively analyzed the data of 23 patients who developed acneiform eruption due to chemotherapeutic agents between May 2007 and April 2011. The drugs causing acneiform eruption, clinical features of eruption, other associated dermatologic adverse reactions and the treatment modalities used for the acneiform reaction were noted. Results: EGFR inhibitors such as erlotinib and cetuximab were the main drugs causing acneiform eruption in 21 patients. Everolimus and bevacizumab in combination with irinotecan were responsible in two patients. The eruption occurred on the face in all patients. The trunk, neck and the scalp were other affected body parts in some patients. The periorbital area on the face was generally spared. Xerosis and paronychia were the main associated adverse cutaneous reactions. Trichomegaly was another finding in two patients. The patients, who could have been followed, responded to topical or systemic antibiotics, or some medications for acne vulgaris/rosacea. Chemotherapy could be continued in all patients. Conclusion: Dermatologists need to know the specific eruptions occurring with chemotherapy drugs, especially EGFR inhibitors in order to develop the best approach without discontinuation of cancer therapy. Acneiform eruptions due to chemotherapeutics are most commonly seen on the face sparing periorbital area. Other reactions including mainly xerosis, paronychia and trichomegaly can also occur.

We have reviwed that there is a dramatic increase in the frequency of hand-foot-mouth disease at Dermatovenerology Department of İstanbul Medical Faculty in June 2013 compared to previous years. When we compared these data with those of June 2011, we have determined a significant difference statistically. We have learned from the authorities of City Health Administrative that they had not been reported about this issue. Although it is difficult to comment based on the data of a single clinic, we want to draw attention that there is a possibility for epidemic disease and a need for national data about this disease.