title: Warfarin-induced skin necrosis. A cutaneous sign of malignancy?
abstract: Patchy necrosis of the skin is a rare and unpredictable complication of oral anticoagulant therapy. Of the four patients that we have seen with this disorder, three had metastatic adenocarcinoma; in two, this was an unexpected finding. The association of a malignant neoplasm with warfarin-induced skin necrosis has not been emphasized previously. Whether such necrosis represents a clue to the presence of cancer or occurs only coincidentally in patients requiring anticoagulant therapy because of adenocarcinoma-associated thrombophlebitis must await further experience. A congenital or acquired deficiency of protein C may be the primary initiating factor.
mesh_terms: D000230:Adenocarcinoma / Q000150:complications*; D000368:Aged; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology; D005260:Female; D005528:Foot / Q000473:pathology; D006023:Glycoproteins / Q000172:deficiency; D006801:Humans; D007866:Leg / Q000473:pathology; D008297:Male; D009336:Necrosis; D009362:Neoplasm Metastasis; D010190:Pancreatic Neoplasms / Q000150:complications; D011486:Protein C; D012811:Sigmoid Neoplasms / Q000150:complications; D012872:Skin Diseases, Vesiculobullous / Q000139:chemically induced* / Q000209:etiology / Q000473:pathology; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D006023:Glycoproteins; D011486:Protein C; D014859:Warfarin