The value of malignancy evaluation in patients with dermatomyositis

Dermatomyositis (DM) has been linked to internal malignancy in adult patients. However, the value of an extensive malignancy evaluation in patients with DM is controversial. Fifty-seven patients who had DM with malignancies, in whom data were available regarding the discovery of malignancy, have been analyzed. Fifty-three of these were reported previously. There were sixty-seven malignancies in the fifty-seven patients. The malignancy preceded (26 cases), followed (23 cases), or occurred with the DM (18 cases). A "blind" (nondirected) malignancy search was not of value in any of the cases analyzed. Rather, the tumors were discovered in forty cases by history (preceding tumor, or abnormal symptoms), in fourteen cases by physical examination, or in twelve cases by abnormal laboratory findings (chest x-ray, urinalysis, stoll guaiac, etc). One case was not discovered until autopsy (adenocarcinoma of the broad ligament). Analysis of tumor sites further negates the value of a malignancy work-up, because most (greater than 90%) tumors occur in areas not amenable to a "routine malignancy search." In several instances patients had an extensive search, without having complete physical examinations. Malignancy evaluations should be directed by abnormal history, physical findings, or routine laboratory testing.