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Florid cutaneous papillomatosis
Other Resources UpToDate PubMed

Florid cutaneous papillomatosis

Contributors: Kimberley R. Zakka MD, Vivian Wong MD, PhD, Whitney A. High MD, JD, MEng, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Florid cutaneous papillomatosis (FCP), also known as Schwartz-Burgess syndrome, is a rare, obligatory paraneoplastic disease characterized by the rapid and widespread eruption of verrucous, skin-colored papules that may be asymptomatic or pruritic. The lesions of FCP are clinically indistinguishable from human papillomavirus (HPV)-related verruca, but no viral particles are identified in the lesions.

FCP is most commonly associated with adenocarcinoma of gastrointestinal origin. Cancers of the lung, breast (male / female), bladder, liver and bile ducts, prostate, ovary, and uterus have also been associated with FCP. Typically, the disease course mirrors that of the underlying malignancy. The etiology of FCP has yet to be elucidated, although many studies have postulated the presence of a growth factor similar to human epidermal growth factor or transforming growth factor alpha, produced by the underlying malignancy.

FCP may occur with other paraneoplastic cutaneous markers including malignant acanthosis nigricans, Leser-Trélat sign, tripe palms, pachydermatoglyphy, palmoplantar keratoderma, and hypertrichosis lanuginosa acquisita.

Codes

ICD10CM:
D36.9 – Benign neoplasm, unspecified site

SNOMEDCT:
39843000 – Cutaneous papillomatosis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Common warts (verruca vulgaris) – A skin infection due to HPV. The resultant skin-colored papules are clinically indistinguishable from FCP. Common warts tend to favor the digits and extremities. However, widespread warts are observed in patients who are immunosuppressed or immunodeficient.
  • Epidermodysplasia verruciformis (Lewandowsky-Lutz dysplasia) – A rare autosomal recessive disorder associated with a high susceptibility to common HPV and epidermodysplasia verruciformis-associated HPV infection. Clinically, lesions present as scaly papules and red-to-brown plaques on the face, trunk, hands, feet, and upper and lower extremities. Patients are at high risk for malignant skin tumors. Look for a positive family history and an early disease onset (before adulthood). Genetic studies reveal a mutation of the EVER1 or EVER2 gene.
  • Bazex syndrome (acrokeratosis neoplastica) – A rare paraneoplastic disease associated with psoriasiform changes to the nails, followed by a gradual eruption of diffuse thickening and scaling of the fingers, palms, toes, and soles. It is associated with squamous cell carcinoma of the upper respiratory and gastrointestinal tract.
  • Basal cell nevus syndrome (Gorlin syndrome / nevoid basal cell carcinoma syndrome) – A rare autosomal dominant disease associated with multiple basal cell carcinomas, often developing early in life. The lesions are pigmented papules and nodules that could resemble warts. Look for a positive family history and an early disease onset (before adulthood). Genetic studies reveal a mutation in the chromosome 9q22-31 region. Basal cell nevus syndrome is not associated with systemic malignancy.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:04/26/2022
Last Updated:05/02/2022
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Florid cutaneous papillomatosis
A medical illustration showing key findings of Florid cutaneous papillomatosis : Dorsum of hand, Face, Widespread distribution, Pruritus, Verrucous scaly papules
Copyright © 2022 VisualDx®. All rights reserved.