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Eruptive skin tags and keratoacanthomas in a patient with prolactinoma and colonic polyposis.

Mercedes Rodríguez-Serna, Department of Dermatology, Hospital General Universitario, Avda Tres Cruces s/n, E-46014 Valencia (Spain) Appendageal tumors may be markers for internal malignancies and predict the nature of this malignancy which may occur 50-60 years later [1,2]. This association between skin tags and colonic polyposis in patients with acromegaly is well known [3], and multiple keratoacanthomas have been associated with a wide range of internal malignancies [2, 4], We present the case of a patient with eruptive skin tags and keratoacanthomas associated with a prolactinoma and colonic polyposis. A 55-year-old man had been operated on for a prolactinoma in 1986. Due to calcification, resection was only partial at the time. In 1990 the patient consulted our department for the presence of multiple eruptive skin lesions which had appeared for the first time, 4 years previously, coinciding with the onset of tumor symptoms. The lesions had been periodically removed but recurred eruptively. Physical examination revealed a moderately obese man with slight gynecomastia. On the thorax and upper limb roots multiple soft peduncular lesions, some pigmented and others skin-colored, which corresponded to skin tags, were observed. In addition, a smaller number of hyperkeratotic lesions with central crater-like regions suggesting keratoacanthomas were also found (fig. 1). Histology confirmed the clinical diagnosis. Hemogram and glycemia values were within normal limits. Growth hormone and somatomedin C levels were also normal, whereas prolactin concentration was 250 ng/ml (tumoral range; normal values 0-20 ng/ml). Colonoscopy revealed the presence of 10 adenomatous polyps in the rectum and sig-moid, which were removed. Histology corresponded to adenomatous polyps. CT brain scan demonstrated an increase in the prolactinoma, with regard to the last CT control after surgery. The patient refused surgical ablation of the tumor. Treatment was started with bromo-criptine, but the patient stopped it after a few weeks due to digestive intolerance. At