HERPES-ZOSTER AND INTERNAL MALIGNANCY

Herpes zoster (HZ) often occurs concomitantly with various internal ma lignancies, most commonly hematologic in origin. Authors in the past p roposed that HZ was a marker for internal malignancy, since it is ofte n found in association with a malignancy. A critical review of the lit erature revealed that when HZ andmalignancy occur in the same individu al, rarely does HZ precede the malignancy, but usually follows it. Man y studies have evaluated HZ in cancer patients, but only three studies have evaluated the occurrence of malignancy after the diagnosis of HZ , and all found no increased incidence of internal malignancy in patie nts with HZ. Since HZ is a poor marker for internal malignancy, extens ive workups to find occult malignancy are not indicated. In rare cases , however, HZ precedes a malignancy. We therefore recommend a baseline history and physical examination, with further directed workup only i f there are abnormal finding.