Malignancy in dermatomyositis: A retrospective study of 201 patients seen at the University of Pennsylvania

  • Kimberly Bowerman
    Affiliations
    Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania

    Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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  • David R. Pearson
    Affiliations
    Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania

    Warren Alpert Medical School at Brown University, Providence, Rhode Island
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  • Joyce Okawa
    Affiliations
    Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania

    Warren Alpert Medical School at Brown University, Providence, Rhode Island
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  • Victoria P. Werth
    Correspondence
    Reprint requests: Victoria P. Werth, MD, Department of Dermatology, Perelman Center for Advanced Medicine, Ste 1-330A, 3400 Civic Center Blvd, Philadelphia, PA 19104.
    Affiliations
    Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania

    Warren Alpert Medical School at Brown University, Providence, Rhode Island
    Search for articles by this author
Published:March 02, 2020DOI:https://doi.org/10.1016/j.jaad.2020.02.061

      Background

      There is an increased incidence of malignancy in patients with dermatomyositis. It is unknown if the risk differs between the subtypes of dermatomyositis.

      Objective

      To (1) compare the prevalence of malignancy-associated dermatomyositis between patients with classic and clinically amyopathic disease and (2) determine factors associated with an increased risk of malignancy-associated disease.

      Methods

      Retrospective cohort study of 201 patients with adult-onset dermatomyositis prospectively enrolled in a longitudinal dermatomyositis database between July 2008 and April 2018 at an outpatient dermatology urban tertiary referral center. The main outcome measure was a diagnosis of malignancy, excluding nonmelanoma skin cancer.

      Results

      There were 201 patients with adult-onset dermatomyositis: 142 (71%) classic and 59 (29%) clinically amyopathic. Within 2 years of diagnosis, the prevalences of malignancy-associated classic and clinically amyopathic dermatomyositis were 9.9% and 1.7%, respectively. In this time period, patients who were older at dermatomyositis diagnosis ( P = .01) and had the classic subtype ( P = .04) were significantly more likely to have an underlying malignancy on multivariable regression analysis.

      Limitations

      This was a retrospective study of prospectively collected data at a single tertiary referral center.

      Conclusion

      Older age and classic dermatomyositis are independent risk factors for malignancy-associated dermatomyositis within 2 years of disease onset.

      Key words

      Abbreviations used:

      ANA ( antinuclear antibody), CADM ( clinically amyopathic dermatomyositis), CDM ( classic dermatomyositis), CI ( confidence interval), DM ( dermatomyositis), ETDM ( early treated dermatomyositis), IRB ( institutional review board), MA ( malignancy-associated), MA-CADM ( malignancy-associating clinically amyopathic dermatomyositis), MA-CDM ( malignancy-associated classic dermatomyositis), MA-DM ( malignancy-associated dermatomyositis), NXP-2 ( nuclear matrix protein 2), OR ( odds ratio)
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