Dermatomyositis — SCE Dermatology MCQ

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ModerateConnective Tissue & VasculitisDermatomyositisSCE Dermatology

A 55-year-old woman with known dermatomyositis presents with progressive proximal muscle weakness and a heliotrope rash of her upper eyelids. She also has erythematous papules over her metacarpophalangeal and interphalangeal joints. Which malignancy screening is most important?

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Correct answer: B — CT chest/abdomen/pelvis

The correct answer is B, CT chest/abdomen/pelvis. This woman has classic adult dermatomyositis (heliotrope rash, Gottron papules over the MCP and IP joints, proximal myopathy), a condition with a well-established paraneoplastic association, most commonly ovarian, lung, pancreatic, gastric and colorectal cancers, with risk highest in the first one to three years after diagnosis. UK dermatology guidance therefore recommends that all adults with new dermatomyositis undergo malignancy screening, and CT of the chest, abdomen and pelvis is the core imaging investigation because it captures the majority of the associated solid tumour sites in a single study. This should be combined with clinical examination, basic bloods, and age/sex-appropriate screening (mammography, pelvic ultrasound/CA-125, PSA), particularly in patients over 40 or with high-risk antibody profiles (e.g. anti-TIF1-gamma).

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions