Florid cutaneous papillomatosis

Overview

Florid Cutaneous Papillomatosis (FCP) is a rare paraneoplastic dermatological condition characterized by the sudden appearance of numerous wart-like skin lesions (papillomas), particularly on the hands and face. It is considered a cutaneous marker for internal malignancies, most commonly gastric carcinoma. FCP is often associated with acanthosis nigricans and other paraneoplastic skin syndromes, and its presence can be an early indicator of an undiagnosed internal cancer.

Causes

Florid Cutaneous Papillomatosis is caused by underlying internal malignancies, especially adenocarcinomas. The most frequently associated cancers include:

• Gastric adenocarcinoma (most common)

• Bladder, lung, breast, or pancreatic cancers

• Other gastrointestinal tract malignancies

The condition is believed to result from tumor-derived growth factors (such as transforming growth factor-alpha) that stimulate keratinocyte proliferation, leading to rapid formation of papillomatous lesions.

Symptoms

Florid Cutaneous Papillomatosis typically presents with distinct skin manifestations, often appearing rapidly and in large numbers. Common symptoms include:

• Sudden eruption of multiple papillomas (wart-like growths)

• Lesions primarily on the face, neck, scalp, and hands

• Symmetrical distribution of growths

• Lesions may resemble viral warts but are not caused by HPV

• May be associated with other paraneoplastic signs:

  • Acanthosis nigricans (dark, velvety skin patches)

  • Tylosis (thickening of the palms and soles)

  • Tripe palms (velvety, rugose palmar skin)

Diagnosis

Diagnosis of FCP is clinical but must include a thorough search for underlying malignancy. Diagnostic workup may include:

• Clinical examination: Recognition of typical skin lesions and associated paraneoplastic findings

• Skin biopsy: Shows papillomatous hyperplasia and hyperkeratosis without viral cytopathic effects

• Cancer screening:

  • Upper GI endoscopy and imaging (CT/MRI) to look for gastric or other internal tumors

  • Tumor marker evaluation (e.g., CEA, CA 19-9) if indicated

• Histopathological examination: To distinguish from viral warts or other skin conditions

Treatment

Treatment of Florid Cutaneous Papillomatosis primarily involves managing the underlying malignancy. Symptomatic relief for skin lesions can be provided but is typically secondary. Treatment options include:

• Oncologic treatment: Surgery, chemotherapy, or radiotherapy directed at the associated cancer

• Topical treatments: Keratolytics or retinoids may be used for symptomatic skin relief

• Cryotherapy or electrosurgery: For removal of bothersome papillomas

• Dermatological follow-up: To monitor the skin and track response to cancer treatment

Prognosis

The prognosis of Florid Cutaneous Papillomatosis depends largely on the underlying malignancy. In many cases, FCP appears before or concurrently with cancer diagnosis and can serve as an early warning sign. Lesions may regress partially or completely with effective treatment of the cancer. However, recurrence of skin symptoms may indicate cancer progression or recurrence, and long-term surveillance is often necessary.