Paraneoplastic Psoriasiform Dermatosis in Melanoma
No, there is no well-established paraneoplastic syndrome associated with melanoma that specifically presents as diffuse psoriatic-like plaques sparing the face. While melanoma is associated with various paraneoplastic syndromes, the dermatological manifestations described in the literature do not include this specific presentation pattern 1, 2.
Paraneoplastic Syndromes Actually Associated with Melanoma
The documented paraneoplastic syndromes in melanoma patients include:
Neurological Manifestations (Most Common)
- Melanoma-associated retinopathy is the most frequently reported paraneoplastic syndrome in melanoma, characterized by retinal abnormalities rather than skin findings 1
- Paraneoplastic encephalitis and cerebellar degeneration are among the most common neurological presentations, mediated by autoantibodies against neuronal or tumor antigens 1
Dermatological Considerations
- Paraneoplastic dermatological syndromes can occur with melanoma, but they do not typically present as psoriasiform plaques 1, 2
- The literature describes various skin paraneoplastic syndromes (such as Bazex syndrome, acanthosis nigricans, dermatomyositis, and necrolytic migratory erythema), but these are more commonly associated with other malignancies, not melanoma 2
Hematological Manifestations
- Paraneoplastic granulocytosis from ectopic G-CSF production has been documented in metastatic melanoma, though rare (6 out of 626 patients in one series) 3
Critical Differential Diagnosis
When evaluating psoriatic-like plaques in a melanoma patient, consider:
Alternative Explanations
- Checkpoint inhibitor-related immune adverse events should be ruled out if the patient is receiving immunotherapy, as these can mimic paraneoplastic syndromes 4
- Metastatic disease must be excluded through appropriate imaging, as new skin lesions may represent cutaneous metastases rather than paraneoplastic phenomena 4
- Pre-existing or unrelated psoriasis that may have been exacerbated by cancer or its treatment 4
Diagnostic Approach
- Document evidence of target organ inflammation through biopsy when the diagnosis is unclear 4
- Advanced imaging (CT, MRI, or PET-CT) may be necessary to distinguish between metastases and paraneoplastic manifestations 4
Clinical Pitfalls
The absence of facial involvement does not establish a paraneoplastic diagnosis. The pattern you describe (diffuse psoriatic-like plaques sparing the face) is not a recognized paraneoplastic syndrome associated with melanoma in current medical literature 1, 2. This presentation warrants:
- Skin biopsy to establish histopathologic diagnosis
- Evaluation for cutaneous metastases
- Assessment for drug-related reactions if on systemic therapy
- Consideration of coincidental inflammatory dermatoses
If paraneoplastic syndrome is suspected based on other clinical features, obtain comprehensive paraneoplastic antibody panels and focus on neurological and ophthalmological evaluation, as these are the predominant manifestations in melanoma 1.