In July 2005, a 65-year-old man visited our department for evaluation of numerous round brownish macules and patches with slightly elevated rims on the trunk, face, and limbs that had developed about 1 year before his examination (Fig. 1). There was no associated pruritus or pain. A clinical diagnosis of disseminated superficial porokeratosis (DSP), but not disseminated superficial actinic porokeratosis (DSAP), was made because the lesions were located not only in sun-exposed areas but also in sun-protected areas including the trunk. A skin biopsy specimen taken from the elevated rim of a lesion on the patient’s abdomen revealed cornoid lamellae and some necrotic kera- tinocytes, which were consistent with porokeratosis (Fig. 2). Laboratory tests including liver function tests and kidney function tests showed no remarkable findings.
Fig. 1. Numerous, round and brownish macules and patches with elevated borders.
In June 2004, he had presented to the Department of Internal Medicine with abdominal discomfort. A diagnostic gastrofiberscope showed an elevated lesion on the stomach wall, and additional diagnostic evaluations including endoscopic biopsy and computed tomography revealed his lesion as early gastric cancer, poorly differentiated type. Subsequently he underwent surgical treatment, a subtotal gastrectomy, and no further treatment was needed.
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At about the same time that early gastric cancer was diagnosed, disseminated skin lesions developed. He said he had had similar skin lesions for some time prior to his visit to our department. However, the previous lesions were scattered just on the trunk, not disseminated, and the rims of the lesions were not accentuated. Thus we determined that the DSP developed almost concurrently with diagnosis of gastric cancer.
Fig. 2. (A) Two cornoid lamellae, the histopathological hallmark of porokeratosis (H&E stain, x40). (B) Cornoid lamella showing stacked parakeratosis in an area of delled epidermis (H&E stain, x100).
He revisited our department in June 2007 with slightly improved lesions. During the 2 years following the gastrectomy, he had received no further treatment for the gastric cancer, and the skin lesions did not increase in size or number. They responded modestly to topical steroids. cialis 5 mg