Malignancies in bullous pemphigoid: A controversial association

Area of Science:

• Dermatology
• Oncology
• Immunology

Background:

• Bullous pemphigoid (BP) is an autoimmune blistering disease affecting the skin's basement membrane zone.
• A potential association between BP and underlying malignancies (pemphigoid associated with malignancies, PAM) has been suggested but remains debated.
• Pathogenetic theories propose cross-reactivity between tumor antigens and BP antigens, triggering an autoimmune response.

Purpose of the Study:

• To review the epidemiology, pathogenesis, and clinical/histological features of pemphigoid associated with malignancies (PAM).
• To evaluate the evidence supporting the correlation between bullous pemphigoid and cancer.
• To provide recommendations for oncological screening in specific patient populations.

Main Methods:

• Extensive review of English-language published literature.
• Focus on epidemiological data, pathogenetic theories, and clinical/histological aspects of PAM.
• Identification and analysis of reported cases of PAM.

Main Results:

• A total of 40 cases of PAM were identified from the literature review.
• Of these, 33 cases were associated with solid tumors.
• Seven cases were linked to hematological malignancies.

Conclusions:

• The association between bullous pemphigoid and malignancy warrants clinical consideration.
• Oncological screening is recommended for patients with early-onset BP, a history of cancer, suspicious symptoms, or refractory disease.
• Awareness of PAM is crucial for timely diagnosis and management.