Necrolytic migratory erythema: unresolved problems in diagnosis and pathogenesis. A case report and literature review

Necrolytic migratory erythema is a distinctive cutaneous eruption that occurs in patients with malignant glucagon-secreting tumors of the pancreas. Recognition of this erosive dermatitis as a cutaneous manifestation of an internal malignancy can result in tumor detection and surgical removal prior to metastasis. The case history of a forty-year-old diabetic woman with necrolytic migratory erythema associated with a metastatic glucagon-secreting islet cell tumor of the pancreas is presented. Prior to diagnosis, she had been treated with topical steroids and Mycostatin powder for a recurrent perioral, acral, and intertriginous dermatitis. Because of apparent responsiveness to these medications, the diagnosis of necrolytic migratory erythema was not considered, and the diagnosis of pancreatic carcinoma was delayed for over one year. Wider recognition of the distinctive clinical and histopathologic features of necrolytic migratory erythema should result in earlier detection and possible surgical cure of the associated glucagonoma.