Pruritus pp 283-287 | Cite as


  • Elke WeisshaarEmail author


Cancers as a cause of acute or chronic itch are less frequently observed than hematological malignancies but recently non-melanoma skin cancers have been described as the most common type of malignancy-associated itch. Cancers can cause itch by local effects on the tissue or by systemic effects to cancer, by side-effects of treatment and severe xerosis cutis. Itch in the absence of any primary skin disease should be a warning to rule out an underlying malignancy. If suspected a precise dermatological and a general examination are necessary including a thorough medical history, dermatological and physical examination, laboratory tests and radiological diagnostics. In case of non-melanoma skin cancer the whole skin needs to be examined carefully and skin biopsy is frequently needed. If a solid tumor is suspected the whole sequence of investigations including laboratory and technical (e.g. computertomography, magnetic resonance tomography, endoscopy) screening might be necessary to diagnose the underlying cause of itch. Treatment centers on therapy of the underlying malignancy paralleled by symptomatic topical and systemic medications. This chapter summarizes all relevant information on itch in cancers including non-melanoma skin cancer.


Cancer Itch Malignancy Malignant itch Pruritus 


  1. 1.
    Chiang HC, Huang V, Cornelius LA. Cancer and itch. Semin Cutan Med Surg. 2011;30:107–12.CrossRefPubMedGoogle Scholar
  2. 2.
    Davis MP, Frandsen JL, Walsh D, Andresen S, Taylor S. Mirtazapine for pruritus. J Pain Symptom Manag. 2003;25:288–91.CrossRefGoogle Scholar
  3. 3.
    Davis MP, Kirkova J, Lagman R, Walsh D, Karafa M. Intolerance to mirtazapine in advanced cancer. J Pain Symptom Manag. 2011;42:e4–7.CrossRefGoogle Scholar
  4. 4.
    Fett N, Haynes K, Propert KJ, Margolis DJ. Five-year malignancy incidence in patients with chronic pruritus: a population-based cohort study aimed at limiting unnecessary screening practises. J Am Acad Dermatol. 2014;70:651–8.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hundley JL, Yosipovitch G. Mirtazapine for reducing nocturnal itch in patients with chronic pruritus a pilot study. J Am Acad Dermatol. 2004;50(6):889–91.CrossRefPubMedGoogle Scholar
  6. 6.
    Johannesdottir SA, Farkas DK, Vinding GR, Pedersen L, Lamberg A, Sorensen HT, et al. Cancer incidence among patients with a hospital diagnosis of pruritus: a nationwide Danish cohort study. Br J Dermatol. 2014;171:839–46.CrossRefPubMedGoogle Scholar
  7. 7.
    Kilic A, Gul U, Soylu S. Skin findings in internal malignant diseases. Int J Dermatol. 2007;46:1055–60.CrossRefPubMedGoogle Scholar
  8. 8.
    Kwatra SG, Mills KC, Zeitany A, Pearce DJ, Williford PM, D’Agostino Jr RB, Yosipovitch G. Pain and nonmelanoma skin cancer in transplant patients. J Am Acad Dermatol. 2012;67:1387–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Lee JJ, Giroud SD, Carlberg VM, Mostaghimi A. Effective use of mirtazapine for refractory pruritus associated with carcinoma en cuirasse. BMJ Support Palliat Care. 2014. doi: 10.1136/bmjspcare-2014-000790. pii: bmjspcare-2014-000790, [Epub ahead of print].PubMedCentralGoogle Scholar
  10. 10.
    Lober CW. Should the patient with generalized pruritus be evaluated for malignancy? J Am Acad Dermatol. 1988;19:350–2.CrossRefPubMedGoogle Scholar
  11. 11.
    Mills KC, Kwatra SG, Feneran AN, Pearce DJ, Williford PM, D’Agostino RB, Yosipovitch G. Itch and pain in nonmelanoma skin cancer: pain as an important feature of cutaneous squamous cell carcinoma. Arch Dermatol. 2012;148:1422–3.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Phan NQ, Lotts T, Antal A, Bernhard JD, Ständer S. Systemic kappa opioid receptor agonists in the treatment of chronic pruritus: a literature review. Acta Derm Venereol. 2012;92:555–60.CrossRefPubMedGoogle Scholar
  13. 13.
    Sommer F, Hensen P, Böckenholt B, et al. Underlying diseases and co-factors in patients with severe chronic pruritus: a 3-year retrospective study. Acta Derm Venereol. 2007;87:510–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Ständer S, Böckenholt B, Schürmeyer-Horst F, Weishaupt C, Heuft G, Luger TA, Schneider G. Treatment of chronic pruritus with the selective serotonin re-uptake inhibitors paroxetine and fluvoxamine: results of an open-labeled, two-arm proof-of-concept study. Acta Derm Venereol. 2009;89:45–51.CrossRefPubMedGoogle Scholar
  15. 15.
    Ständer S, Siepmann D, Herrgott I, Sunderkotter C, Luger TA. Targeting the neurokinin receptor 1 with aprepitant: a novel antipruritic strategy. PLoS ONE. 2010;5, e10968.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ständer S, Weisshaar E, Mettang T, Szepietowski JC, Carstens E, Ikoma A, Bergasa NV, Gieler U, Misery L, Wallengren J, Darsow U, Streit M, Metze D, Luger TA, Greaves MW, Schmelz M, Yosipovitch G, Bernhard JD. Clinical classification of itch: a position paper of the International Forum for the study of itch. Acta Derm Venereol. 2007;87(4):291–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Weisshaar E. Intractable chronic pruritus in a 67-year-old man. Acta Derm Venereol. 2008;88:488–90.CrossRefPubMedGoogle Scholar
  18. 18.
    Weisshaar E, Apfelbacher CJ, Jäger G, et al. Pruritus as a leading symptom – clinical characteristics and quality of life in German and Ugandan patients. Br J Dermatol. 2006;55:957–64.CrossRefGoogle Scholar
  19. 19.
    Weisshaar E, Dalgard F. Epidemiology of itch: adding to the burden of skin morbidity. Acta Derm Venereol. 2009;89:339–50.CrossRefPubMedGoogle Scholar
  20. 20.
    Weisshaar E, Szepietowski JC, Darsow U, et al. European guideline on chronic pruritus. Acta Derm Venereol. 2012;92:563–81.CrossRefPubMedGoogle Scholar
  21. 21.
    Weisshaar E, Weiss M, Mettang T, Yosipovitch G, Zylicz Z. Paraneoplastic itch: an expert position statement from the Special Interest Group (SIG) of the International Forum on the Study of Itch (IFSI). Acta Derm Venereol. 2015;95(3):261–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Yosipovitch G, Mills KC, Nattkemper LA, Feneran A, Tey HL, Lowenthal BM, Pearce DJ, Williford PM, Sangueza OP, D’Agostino Jr RB. Association of pain and itch with depth of invasion and inflammatory cell constitution in skin cancer: results of a large clinicopathologic study. JAMA Dermatol. 2014;150:1160–6.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Yosipovitch G, Tan A, LoSicco K, Manabat CG, Kannagra A, Carroll C, Chan YH, Ng P, Jorizzo J. A comparative study of clinical characteristics, work-up, treatment, and association to malignancy in dermatomyositis between two tertiary skin centers in the USA and Singapore. Int J Dermatol. 2013;52:813–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Zylicz Z, Krajnik M, van Sorge AA, Constantini M. Paroxetine in the treatment of severe non-dermatological pruritus: a randomized, controlled trial. J Pain Symptom Manag. 2003;26:1105–12.CrossRefGoogle Scholar
  25. 25.
    Zylicz Z, Smits C, Krajnik M. Paroxetine for pruritus in advanced cancer. J Pain Symptom Manag. 1998;16:121–4.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  1. 1.Department of Clinical Social Medicine, Occupational and Environmental DermatologyUniversity Hospital, Ruprecht Karls University HeidelbergHeidelbergGermany

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