Paraneoplastic pemphigus (PNP) can cause oral ulcerations. These ulcerations may be the first indication that the patient has an occult malignancy. The diagnosis should be suspected when certain findings are present.


Patient selection: presence of unexplained oral ulcerations


The diagnosis is relatively straightforward if:

(1) the patient is known to have a malignancy

(2) the ulcers regress after a tumor is treated and reappear on relapse

(3) skin lesions of PNP are present elsewhere


The diagnosis should be suspected in a patient:

(1) with diffuse and persistent oral ulcerations.

(2) with ulcers that continue to progress over time.

(3) with ulcers that are resistant to standard therapy


The workup consists of serum assays for autoantibodies, skin or mucosal biopsies with immunofluorescence and an examination to detect an occult tumor. The examinations may need to be repeated several times before a tumor is found.


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