When is the index of suspicion high for paraneoplastic systemic sclerosis in terms of clinical and serological presentation and how will you work it up?

This is a great question. Data on the risk for malignancy in newly diagnosed scleroderma patients has been emerging for the past 10 years or so. To date, it appears that the strongest risk factors may be autoantibody with RNA polymerase 3 antibodies showing consistent increase in risk amongst scleroderma patients and compared to the general population. Interestingly centromere + patients seem to be at lower risk compared to similar age and gender-matched patients in the general population. Other antibodies also seem to confer some risk but these are not as clear or are not widely commercially available. In our center, we make sure that all newly diagnosed scleroderma patients complete their age-appropriate cancer screening. For patients wit...