Florid cutaneous papillomatosis
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.
D36.9 – Benign neoplasm, unspecified site
39843000 – Cutaneous papillomatosis
Differential Diagnosis & Pitfalls
- (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.
- (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.
- (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.
- (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.