Acral lentigines: A new paraneoplastic syndrome

Case 1: A 60-year-old man presented with several asymptomatic, symmetrical, well-demarcated, brown macules, averaging 1-3 mm in diameter, on his palms and soles (Figs. 1 and 2). He had noticed the macules about 1 year earlier. He was diagnosed with diffuse large cell lymphoma of the small bowel at about the same time, and subsequently underwent surgery and chemotherapy. Local recurrence was discovered about 1.month before his visit to our clinic. He was undergoing a chemotherapy regimen that included cisplatin, ifosfamide, dexamethasone, and etoposide (VP16). Case 2: A 46-year-old woman of Ethiopian origin presented with a few dozen asymptomatic, symmetrical, well-demarcated brown macules, of 2-3 mm in diameter, on her soles (Fig. 3) that had appeared within the last few months. Her palms were not involved. One year before, she had been diagnosed with carcinoma of the breast. She underwent lumpectomy, radiotherapy, and was currently being treated with tamoxifen. There was no evidence of recurrence. A biopsy performed on one macule showed minimal changes consisting of slight elongation of the rete ridges, and increased melanin in the melanocytes and basal cells, compatible with simple lentigo. Case 3: A 50-year-old man with a history of adenocarcinoma of the stomach was referred to our clinic by his GP because of the appearance of symmetrical, hyperpigmented, well-demarcated macules involving his soles. The lesions were completely asymptomatic, and the patient had been unaware of their existence until his GP noticed them on a physical examination. Case 4: A 52-year-old woman had noticed a few symmetrical, well-demarcated, brown macules, averaging 1-3 mm in diameter, on her palms and soles (Fig. 4). Her medical history included carcinoma of the breast. She underwent lumpectomy and radiotherapy and was currently receiving crystallized adriamycin for metastatic disease.