TABLE 2.
Case 1 | Case 2 | Case 3 | |
---|---|---|---|
Patient | 1 | 2 | 3 |
Age/Race/Sex | 60 yo/Caucasian/Male | 55 yo/Caucasian/Female | 48 yo/African American/Male |
Risk factors | Alcohol, 80 py smoking history | 7.5 py smoking history | 1.25 py smoking history |
Disease site | Hypopharynx | Oropharynx (p16 negative) | Hypopharynx |
Histology | Squamous Cell Carcinoma | Squamous Cell Carcinoma | Squamous Cell Carcinoma |
Clinical presentation |
Figure 1 Skin: hands, feet, and ears with burning and itching Nails: Dryness, flaking, and thickening of fingernails Stress worsened symptoms |
Figure 2 Skin: Raynaud's‐like symptoms with pallor and numbness and focal necrosis of the tip of the right third finger Nails: Raised, brittle yellow, and thickened |
Figure 3 Skin: Diffuse thickening and scaling of palms and soles Dry hyperpigmented patches on the anterior shins Nails: Not affected |
Skin biopsy | Hyperkeratosis, horn cysts with focal intracorneal acute inflammation, psoriaform dermatitis | Not performed | Not performed |
Timing of symptoms | Oncologic and dermatologic sx's developed around same time | Dermatologic sx's preceded oncologic sx's by ~6 mo | Oncologic sx's preceded dermatologic sx's by ~1 mo |
Treatment |
Oncologic: Definitive chemoradiation to 70Gy with concurrent cisplatin Dermatologic: Acitretin |
Oncologic: Definitive chemoradiation to 70 Gy with concurrent cisplatin Dermatologic: Acitretin, clotrimazole/betamethasone, and nitroglycerin |
Oncologic: Definitive chemoradiation to 70Gy with concurrent cisplatin/carboplatin Dermatologic: Triamcinolone and topical urea |
Cancer outcome | Patient remains NED 46 mo post‐treatment | Patient remains NED 40 mo post‐treatment | Died 7 mo post‐treatment due to disease progression and metastases |
Bazex symptom outcome |
Figure 1 Complete resolution with intermittent flare ups responsive to acitretin |
Figure 2 Complete resolution with no flare ups |
Figure 3 Complete resolution seen in hands but only partial resolution in legs and foot |
Abbreviations: Gy, gray; NED, no evidence of disease; py, pack‐year; Sx's, symptoms; yo, year old.