Soft-palate pigmentation in lung disease, including cancer

A study of patients in whom soft-palate pigmentation appeared to be associated with pulmonary disease has been reported. A significant number of these patients had diagnosed or suspected bronchogenic carcinoma. The possibility that this oral finding may be predictive of the presence of lung cancer, or of a high degree of probability of future development of lung cancer, indicates a need for additional investigation. At this point the evidence strongly suggests that when soft-palate pigmentation is seen in a patient with lung disease, cancer should be suspected until it is definitely ruled out. The paucity of patients in whom this sign is seen suggests the need for study by other investigators. ACTH levels should be evaluated, as should plasma zinc values, which have been demonstrated to decrease in lung cancer as well as other diseases. Following the patients prospectively certainly is indicated. In conjunction with the Department of Laboratory Medicine, limited initial additional investigations have been made of the carcinoembryonic antigen (CEA) levels on three of the outpatients reported. These assays used the hemagglutination-inhibition technique and are limited to investigational use by the Food and Drug Administration. In this laboratory the normal CEA level is 5.2 +/- 1.6 ng./ml. Results in two patients with known chronic obstructive pulmonary disease were 5.5 and 5.6 ng./ml. The third patient with soft-palate pigmentation and an undiagnosed pulmonary problem had a CEA level of 10.2 ng./ml. She also had clubbing of the fingers. The senior author would be particularly interested in establishing a registry of similar cases observed by others.