YLink-Routine vs Extensive Malignancy Search for Adult Dermatomyositis
YVONNE Critter Crusader
Polymyositis
A Study of 40 Patients
Objective: To identify potential risk factors and the yield of
routine screens for early detection of malignancy associated with
dermatomyositis (DM) and polymyositis (PM).
Design: Retrospective study of malignancies in all patients with DM
or PM followed up between the years 1981 and 2000 and a review of the
relationship of DM and PM to malignancy, the usefulness of various tests
or examinations for malignancy search, and the patients' course.
Setting: Departments of internal medicine and dermatology in a
teaching hospital.
Patients Forty consecutive adult patients with DM (33 cases) or PM
(7 cases).
Main Outcome Measures: (1) Rate of false-negative results of
routine workup and yield (percentage of positive results) of blind
malignancy search and (2) comparison of 16 characteristics in patients
with malignancy vs those without.
Results: Malignancy occurred in 16 patients: 13 with DM and 3 with
PM. In all cases, the diagnosis of malignancy was made concurrently with
or shortly after the diagnosis of DM or PM. Factors associated with
malignancy were recruitment in the internal medicine department (P =
02), constitutional symptoms (P<.01), a rapid onset of DM or PM (P =
02), the lack of Raynaud phenomenon (P< .01), and a higher mean
erythrocyte sedimentation rate (P<.01) and creatine kinase level
(P<.01). Initial routine search failed to discover 4 malignancies, 3 of
which were discovered at an advanced stage by more extensive
investigations. The positive result yield of blind malignancy search was
only 13% (11 of 87), but reached 28% (5 of 18) for blind
abdominal-pelvic and thoracic computed tomographic scans.
Conclusion: Extensive search for malignancy, particularly computed
tomographic scans, may be warranted in at least a subset of patients
with DM or PM and risk factors of malignancy.
Arch Dermatol. 2002;138:885-890
Author/Article Information
From the Departments of Dermatology (Drs Sparsa, Lebrun,
Bouyssou-Gauthier, Boulinguez, Bédane, and Bonnetblanc) and Internal
Medicine (Drs Liozon, Ly, Soria, Loustaud-Ratti, and Vidal), and the
Immunology Laboratories (Dr Jauberteau), University Hospital of Limoges,
Limoges, France; and the Department of Geriatrics, University Hospitals
of Geneva, Geneva, Switzerland (Dr Herrmann).
Agnès Sparsa, MD; Eric Liozon, MD; François Herrmann, MD, MPH;
Kim Ly, MD; Valérie Lebrun, MD; Pascale Soria, MD; Véronique
Loustaud-Ratti, MD; Marie-Laure Bouyssou-Gauthier, MD; Serge Boulinguez,
MD; Christophe Bédane, MD, PhD; Marie-Odile Jauberteau, MD, PhD;
Elisabeth Vidal, MD; Jean-Marie Bonnetblanc, MD
Corresponding author: Eric Liozon, MD, Service de Médecine Intenre A,
CHRU Dupuytren, 87042, Limoges, France (e-mail: eric....@unilim.fr).
Accepted for publication August 20, 2001.
© 2002 American Medical Association. All rights reserved.
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