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
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Departamento de Dermatología, Hospital Regional Universitario de Málag, Málaga, Spain
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La línea gris vertical indica ratio de incidencia estandarizada de 1.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Figura extraída de: Arendt et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. 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:2 [ "nombre" => "E." "apellidos" => "Gómez-Moyano" ] 2 => array:2 [ "nombre" => "D.J." "apellidos" => "Godoy-Díaz" ] 3 => array:2 [ "nombre" => "L." 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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. The vertical gray line represents a standardized incidence ratio of 1.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eritrodermia en el adulto: un enfoque práctico para el diagnóstico y tratamiento" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Cuellar-Barboza" 1 => "J. Ocampo-Candiani" 2 => "M. Herz-Ruelas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermo-sifiliogr." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 10 | 16 |
| 2024 Octubre | 64 | 46 | 110 |
| 2024 Septiembre | 67 | 21 | 88 |
| 2024 Agosto | 105 | 58 | 163 |
| 2024 Julio | 89 | 29 | 118 |
| 2024 Junio | 76 | 31 | 107 |
| 2024 Mayo | 93 | 29 | 122 |
| 2024 Abril | 76 | 24 | 100 |
| 2024 Marzo | 64 | 33 | 97 |
| 2024 Febrero | 56 | 27 | 83 |
| 2024 Enero | 56 | 30 | 86 |
| 2023 Diciembre | 50 | 17 | 67 |
| 2023 Noviembre | 64 | 24 | 88 |
| 2023 Octubre | 60 | 23 | 83 |
| 2023 Septiembre | 52 | 27 | 79 |
| 2023 Agosto | 50 | 13 | 63 |
| 2023 Julio | 42 | 27 | 69 |
| 2023 Junio | 34 | 25 | 59 |
| 2023 Mayo | 41 | 19 | 60 |
| 2023 Abril | 26 | 22 | 48 |
| 2023 Marzo | 33 | 21 | 54 |
| 2023 Febrero | 35 | 25 | 60 |
| 2023 Enero | 29 | 23 | 52 |
| 2022 Diciembre | 41 | 34 | 75 |
| 2022 Noviembre | 30 | 26 | 56 |
| 2022 Octubre | 32 | 22 | 54 |
| 2022 Septiembre | 33 | 39 | 72 |
| 2022 Agosto | 28 | 41 | 69 |
| 2022 Julio | 22 | 53 | 75 |
| 2022 Junio | 23 | 32 | 55 |
| 2022 Mayo | 30 | 38 | 68 |
| 2022 Abril | 49 | 26 | 75 |
| 2022 Marzo | 51 | 56 | 107 |
| 2022 Febrero | 44 | 32 | 76 |
| 2022 Enero | 48 | 40 | 88 |
| 2021 Diciembre | 41 | 37 | 78 |
| 2021 Noviembre | 46 | 39 | 85 |
| 2021 Octubre | 55 | 67 | 122 |
| 2021 Septiembre | 44 | 47 | 91 |
| 2021 Agosto | 27 | 22 | 49 |
| 2021 Julio | 26 | 23 | 49 |
| 2021 Junio | 29 | 36 | 65 |
| 2021 Mayo | 35 | 37 | 72 |
| 2021 Abril | 72 | 105 | 177 |
| 2021 Marzo | 60 | 42 | 102 |
| 2021 Febrero | 71 | 33 | 104 |
| 2021 Enero | 21 | 18 | 39 |
| 2020 Diciembre | 4 | 4 | 8 |
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