Necrolytic Migratory Erythema

Necrolytic migratory erythema (NME) is a characteristic skin rash most often associated with the glucagonoma, an alpha-cell tumor of the pancreatic islets. It is usually seen as a part of the glucagonoma syndrome, a paraneoplastic syndrome which includes the triad of diabetes mellitus, NME, and weight loss. However, more rarely, NME can also be seen as a part of other clinical entities such as liver disease and intestinal malabsorption; here it is termed the pseudoglucagonoma syndrome. The skin rash is characteristically extremely erythematous, shows superficial epidermal necrosis and often spreads in a centrifugal pattern. The condition is frequently misdiagnosed due in part to its rarity and often is the presenting symptom of the pancreatic islet neoplasm. Thus, timely recognition and treatment can help prevent morbidity from the epidermal dysfunction and mortality from the tumor burden itself, if the neoplasm is identified before metastasis.