Image Gallery: Necrolytic Migratory Erythema Associated With Glucagonoma

DEAR EDITOR, A 57-year-old man with diabetes presented with a 30-year period of pruritic skin lesions concurrent with a 12-kg loss of weight. The lesions presented as generalized arciform, erythematous and eroded plaques with overlying haemorrhagic crust (a). There was associated angular cheilitis and atrophic glossitis (b). The skin biopsy showed three structures within the epidermis: a layer with basaloid keratinocytes, a spiny zone with cleared cytoplasm cells and another part with thickened eosinophilic stratum corneum, suggestive of necrolytic migratory erythema (c). An abdominal computed tomography scan found a pancreatic mass and liver metastases whose biopsy revealed infiltration by a neuroendocrine tumour with glucagon immunoexpression. Plasma glucagon was increased. The skin lesions resolved following treatment with somatostatin analogues.