Herpes zoster and internal malignancy

Herpes zoster (HZ) often occurs concomitantly with various internal malignancies, most commonly hematologic in origin. Authors in the past proposed that HZ was a marker for internal malignancy, since it is often found in association with a malignancy. A critical review of the literature revealed that when HZ and malignancy occur in the same individual, rarely does HZ precede the malignancy, but usually follows it. Many studies have evaluated HZ in cancer patients, but only three studies have evaluated the occurrence of malignancy after the diagnosis of HZ, and all found no increased incidence of internal malignancy in patients with HZ. Since HZ is a poor marker for internal malignancy, extensive workups to find occult malignancy are not indicated. In rare cases, however, HZ precedes a malignancy. We therefore recommend a baseline history and physical examination, with further directed workup only if there are abnormal findings.