Letter to the Editor
Role of Cyanocobalamin Levels in Managing Paraneoplastic Erythroderma: A Practical Approach
Papel de la cianocobalamina en el abordaje práctico de la eritrodermia paraneoplásica
A. Andamoyo-Castañeda, E. Gómez-Moyano
, D.J. Godoy Díaz, L. Martínez Pilar
Corresponding author
Departamento de Dermatología, Hospital Regional Universitario de Málag, Málaga, Spain
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A, recurrent squamous cell carcinoma on the cheek with clinical perineural invasion. B, Superficial spreading melanoma on the knee with a Breslow thickness of 7.70 mm. C, Invasive squamous cell carcinoma on the cheek with a thickness of 6.5 mm. D, Recurrent Merkel cell carcinoma on the right shoulder. E, Verrucous carcinoma with a 5-cm diameter on the knee.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Porcar Saura, M. Pons Benavent, S. Guillén Climent, A. García Vázquez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Porcar Saura" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Pons Benavent" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Guillén Climent" ] 3 => array:2 [ "nombre" => "A." 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Andamoyo-Castañeda, E. Gómez-Moyano, D.J. Godoy Díaz, L. Martínez Pilar" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Andamoyo-Castañeda" ] 1 => array:4 [ "nombre" => "E." "apellidos" => "Gómez-Moyano" "email" => array:1 [ 0 => "elisabeth.gomez.moyano@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "D.J." "apellidos" => "Godoy Díaz" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Martínez Pilar" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Hospital Regional Universitario de Málag, Málaga, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel de la cianocobalamina en el abordaje práctico de la eritrodermia paraneoplásica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1664 "Ancho" => 2917 "Tamanyo" => 150678 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Standardized incidence ratios (SIR) corresponding to 95% confidence intervals shown according to cyanocobalamin level. × indicates 200–600 pmol/L; O, 601–800 pmol/L; and □, greater than 800 pmol/L. The vertical gray line represents a standardized incidence ratio of 1.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In their excellent study on erythroderma, Cuellar-Barboza et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> analyze the various causes of this condition in adults. The etiology is neoplastic or paraneoplastic in 1% of cases, and, within this group, erythroderma is most frequently associated with hematological malignancies and cutaneous T-cell lymphomas, which account for 25%–40% of cases of erythroderma associated with cancer.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Of note, the authors compile a series of laboratory findings and group them by frequency. These have previously been reported in the literature and include elevated erythrocyte sedimentation rate, leukocytosis, eosinophilia, anemia, liver function, and kidney function. They highlight the importance of the eosinophil count in drug reaction with eosinophilia and systemic symptoms syndrome and call to mind the association between eosinophilia and malignant erythroderma. Their approach stresses the usefulness of Sézary cell count analysis in the diagnosis of Sézary syndrome and mycosis fungoides.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Given the difficulty and importance of the diagnosis of paraneoplastic erythroderma, we believe it would be interesting for the protocol put forward by the authors to include simple and accessible biomarkers that could assist in screening for tumors associated with erythroderma. In this sense, various studies have shown that increased levels of cyanocobalamin (vitamin B<span class="elsevierStyleInf">12</span>) are correlated with an increased risk of occult solid and hematologic malignancies.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Pathophysiology is based on the metabolism of cobalamin: under normal conditions, most cobalamin in blood (80%) does not circulate freely and must bind to transport proteins, namely, haptocorrin<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a> or type I transcobalamin,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5,8</span></a> both of which can be synthesized by granulocytes.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a> In addition, the levels of these transport proteins in blood are correlated with serum cobalamin levels, thus explaining the high levels detected in blood dyscrasia.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Nevertheless, high cobalamin levels have also been observed in some solid tumors (e.g., pharynx, esophagus, liver, stomach, biliary tract, pancreas, lung, colon-rectum, prostate, ovary, cervix, and bladder),<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–7</span></a> possibly because the synthesis of type I transcobalamin could be increased by neoplastic cells themselves.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,8</span></a> On the other hand, since haptocorrin<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and type I transcobalamin<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> are metabolized in the liver, primary tumors affecting the liver,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,8</span></a> metastases,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,8</span></a> or other non–tumor-related causes<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,6,8</span></a> would make it possible to detect high serum cobalamin levels owing to the reduced clearance of the binding proteins.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Arendt et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> conclude that, while high cobalamin could be associated with smoking, alcohol, or liver disease, levels above 800 pmol/L are significantly associated with neoplasms, especially hematologic malignancies, such as non-Hodgkin lymphoma, Hodgkin lymphoma, multiple myeloma, and leukemia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). We include the graph from Arendt et al.,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> which shows the risk of diagnosing various types of tumor during the same year plasma cobalamin levels are determined.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">In this sense, Chiche et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> demonstrate the statistically significant association between vitamin B<span class="elsevierStyleInf">12</span> concentrations greater than 1275 pg/mL and hematologic malignancy.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Later studies<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6</span></a> reveal similar results and a poorer prognosis and higher mortality rates have been demonstrated for patients with cancer and elevated B<span class="elsevierStyleInf">12</span> levels than those with cancer and normal B<span class="elsevierStyleInf">12</span> levels.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, we believe that it would be interesting to include serum cobalamin levels in the erythroderma protocol of Cuellar-Barboza et al.,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> since such a determination is simple, inexpensive, and accessible when screening for paraneoplastic erythroderma, especially that associated with hematologic malignancy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-03-13" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Andamoyo-Castañeda A, Gómez-Moyano E, Godoy Díaz DJ, Martínez Pilar L. Papel de la cianocobalamina en el abordaje práctico de la eritrodermia paraneoplásica. Actas Dermosifiliogr. 2021;112:199–200.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1664 "Ancho" => 2917 "Tamanyo" => 150678 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Standardized incidence ratios (SIR) corresponding to 95% confidence intervals shown according to cyanocobalamin level. × indicates 200–600 pmol/L; O, 601–800 pmol/L; and □, greater than 800 pmol/L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 10 | 16 |
| 2024 October | 64 | 46 | 110 |
| 2024 September | 67 | 21 | 88 |
| 2024 August | 105 | 58 | 163 |
| 2024 July | 89 | 29 | 118 |
| 2024 June | 76 | 31 | 107 |
| 2024 May | 93 | 29 | 122 |
| 2024 April | 76 | 24 | 100 |
| 2024 March | 64 | 33 | 97 |
| 2024 February | 56 | 27 | 83 |
| 2024 January | 56 | 30 | 86 |
| 2023 December | 50 | 17 | 67 |
| 2023 November | 64 | 24 | 88 |
| 2023 October | 60 | 23 | 83 |
| 2023 September | 52 | 27 | 79 |
| 2023 August | 50 | 13 | 63 |
| 2023 July | 42 | 27 | 69 |
| 2023 June | 34 | 25 | 59 |
| 2023 May | 41 | 19 | 60 |
| 2023 April | 26 | 22 | 48 |
| 2023 March | 33 | 21 | 54 |
| 2023 February | 35 | 25 | 60 |
| 2023 January | 29 | 23 | 52 |
| 2022 December | 41 | 34 | 75 |
| 2022 November | 30 | 26 | 56 |
| 2022 October | 32 | 22 | 54 |
| 2022 September | 33 | 39 | 72 |
| 2022 August | 28 | 41 | 69 |
| 2022 July | 22 | 53 | 75 |
| 2022 June | 23 | 32 | 55 |
| 2022 May | 30 | 38 | 68 |
| 2022 April | 49 | 26 | 75 |
| 2022 March | 51 | 56 | 107 |
| 2022 February | 44 | 32 | 76 |
| 2022 January | 48 | 40 | 88 |
| 2021 December | 41 | 37 | 78 |
| 2021 November | 46 | 39 | 85 |
| 2021 October | 55 | 67 | 122 |
| 2021 September | 44 | 47 | 91 |
| 2021 August | 27 | 22 | 49 |
| 2021 July | 26 | 23 | 49 |
| 2021 June | 29 | 36 | 65 |
| 2021 May | 35 | 37 | 72 |
| 2021 April | 72 | 105 | 177 |
| 2021 March | 60 | 42 | 102 |
| 2021 February | 71 | 33 | 104 |
| 2021 January | 21 | 18 | 39 |
| 2020 December | 4 | 4 | 8 |
Show all
