Bazex Syndrome as a Cutaneous Marker of Occult Malignancy: A Report of Two Cases.

Acrokeratosis paraneoplastica (Bazex syndrome) is a rare paraneoplastic dermatosis characterized by psoriasiform lesions predominantly affecting acral sites and is most commonly associated with squamous cell carcinomas of the upper aerodigestive tract. Cutaneous manifestations may precede the diagnosis of the underlying malignancy, making their recognition an important diagnostic clue. We report two cases of Bazex syndrome in older men presenting with characteristic acral and facial psoriasiform lesions. In both patients, skin biopsy revealed nonspecific histopathological findings, while the clinical pattern prompted investigation for an underlying malignancy. The first patient was subsequently diagnosed with metastatic oesophageal squamous cell carcinoma. In the second patient, investigation revealed two synchronous malignancies: a large-cell neuroendocrine carcinoma and an oesophageal squamous cell carcinoma. These cases emphasize the diagnostic value of recognizing the clinical pattern of Bazex syndrome as a marker of underlying malignancy. In patients presenting with compatible acral psoriasiform lesions, particularly older individuals with relevant cancer risk factors, this distinctive clinical pattern should prompt systematic investigation for an occult malignancy.