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Necrolytic Migratory Erythema — SCE Dermatology MCQ

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HardSkin CancerNecrolytic Migratory ErythemaSCE Dermatology

A man has recurrent erosive plaques with a migrating erythematous edge in the groin and perioral region, angular cheilitis, diabetes, weight loss, anaemia and hypoaminoacidaemia. Which tumour most directly unifies the findings?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — A pancreatic alpha-cell neuroendocrine tumour secreting glucagon

Explanation lettering: D = shown as A · C = shown as B · E = shown as C · B = shown as D · A = shown as E

C is correct. Necrolytic migratory erythema with diabetes, catabolism, weight loss, anaemia and amino-acid deficiency is the glucagonoma syndrome, usually from a pancreatic alpha-cell neuroendocrine tumour. Insulinoma produces fasting hypoglycaemia; somatostatinoma may cause diabetes, steatorrhoea and gallstones but not the characteristic migrating eruption; gastrinoma causes acid hypersecretion and refractory ulceration; and serotonin-secreting midgut tumours cause flushing, diarrhoea and valvular disease. Nutritional deficiency can produce a similar necrolytic eruption, so biochemical confirmation and pancreatic imaging are required, but the complete syndrome here strongly identifies glucagon excess.

Reference: PCDS necrolytic migratory erythema guidance: https://www.pcds.org.uk/clinical-guidance/necrolytic-migratory-erythema