Eruptive keloids associated with breast cancer: a paraneoplastic phenomenon?

Keloids are benign dermal fibroproliferative neoplasms that occur at sites of cutaneous injury as a result of abnormal wound recovery. They are characterized by excess accumulation of extracellular matrix with thickened and disorganized collagen bundles. Unlike normal scar tissue, keloids do not regress and may extend beyond the confines of the original wound (1). Although the exact etiology of keloids is poorly understood, it is generally recognized that both genetics and environmental factors contribute to their pathogenesis. Dark-skinned individuals with familial predisposition are particularly susceptible. We present here a case of eruptive keloids associated with breast cancer and discuss the common growth factors associated with the two. An 81-year-old African–American man was referred to dermatology in May 2007 for evaluation of eruptive keloid-like lesions on his trunk. His medical history was remarkable for renal cell carcinoma in 1988 (treated with nephrectomy), congestive heart failure, stage 4 chronic kidney disease, and a long history of typical keloids following mild trauma. He also had a family history of keloids. Cutaneous examination revealed a typical keloid on the helix of the left ear. It also revealed atypical sclerotic hyperpigmented plaques with figurate shapes on the back, bilateral axillae, groin, genitalia, legs, chest and abdomen (Fig. 1A). According to the patient's report these were growing and becoming more pruritic. He denied trauma or injury to any of the new sites. Initially the differential diagnosis was large including mycosis fungoides, sarcoid, and syphilis, but a punch biopsy confirmed a diagnosis of keloids. The patient returned to clinic in early 2008 complaining of enlarging lesions and increasing pruritus unresponsive to topical triamcinolone 0.1%. He was now unable to raise his arms above his head due to extensive axillary keloids. Intralesional triamcinolone therapy was administered, but this purportedly worsened his condition. Pentoxifylline, hydroxyzine, topical clobetasol, and topical imiquimod all failed to provide adequate relief. The patient was referred to radiation oncology for evaluation and he was presented at the University of California Davis dermatology grand rounds. A malignancy screening to rule out a paraneoplastic process was recommended. A few months later he presented to the emergency room for an unrelated issue, and a routine chest X-ray revealed a mass in his right breast. A diagnosis of breast cancer was confirmed on biopsy. The patient then underwent a right total mastectomy. Postoperatively, he noted an immediate resolution of the severe pruritus that had been associated with his keloids. …