Case 1 A 44-year-old patient was admitted to the hospital on February 20, 2006, 9 months after radiotherapy for dermatomyositis (DM) associated with cervical cancer. The patient developed erythema and edema of the face, neck and trunk with pruritus, rupture and gradually developed muscle weakness, muscle pain and difficulty in swallowing, and was diagnosed as DM in the local hospital. The patient was treated with whole pelvic external radiotherapy tumor dose (DT) 20Gy, four field DT 30Gy, and rear-loading radiotherapy point A 27Gy. 9 months after radiotherapy, she developed irregular vaginal bleeding and was transferred to our hospital. The patient was in good health with no history of drug allergy and denied family history of hereditary diseases, tumor and autoimmune system diseases. Physical examination: edema and flushing of the skin on the face and trunk, and significant pressure pain in the liver area. Ultrasound showed a solid hypoechoic mass of 6.2 cm×5.1 cm in the parenchyma of the right lobe of the liver, with clear borders and irregularity, and a slightly larger uterus. A 5.7 cm × 5.2 cm solid slightly hyperechoic inhomogeneous mass was seen in the middle and lower part of the uterus. Laboratory tests: aspartate aminotransferase (AST) 38.7 U/L, creatine phosphokinase (CK) 5 U/L, lactate dehydrogenase (LDH) 334 U/L, hydroxybutyrate dehydrogenase (HBDH) 316 U/L. Diagnosis: uterine body invasion after radiotherapy for cervical cancer; liver metastasis; DM. 2 liver interventions were performed, and the total amount of drugs used in the interventional artery: pinyamycin 48 mg, cisplatin 160mg, 5fluorouracil 3g; 3 cycles of intravenous chemotherapy with pedialyte glycosides 0.4g, pinyamycin 72mg, carboplatin 0.3g were given. Post-loading radiotherapy was given at 32 Gy at site A. DM symptoms gradually disappeared during the treatment. The gynecological examination was performed at the end of treatment: the vaginal vault disappeared, the mucosa was smooth and well dilated; the cervix was 2.5cm×2.5cm in size, slightly rough; the uterus was as large as 40d of pregnancy; the bilateral parametrium showed fibrotic thickening up to the pelvic wall, with poor elasticity. ultrasound showed that the cervix was not large, the echogenicity was not homogeneous, the uterus was still large in volume, with normal morphology; the solid hypoechoic mass in the parenchyma of the right lobe of the liver did not show significant reduction. Laboratory tests: AST 24.5 U/L, CK 4 U/L, LDH 148 U/L, HBDH 153 U/L. He died 3 months later of liver metastasis from cervical cancer. Case 2 The patient was 58 years old and was admitted on July 18, 2006 with a cervical mass found on examination for 4d. The patient developed itchy scalp and erythematous edema due to hair dyeing 2 months ago, and gradually developed erythematous edema with itching and rupture on the face, neck, trunk and upper limbs; and gradually developed muscle weakness, muscle pain and difficulty in swallowing, and was given dexamethasone, vitamin C and penicillin intravenously and paracetamol orally, with no significant improvement in symptoms. Gynecological examination was performed: no abnormalities in the vulva and urethra; vaginal vault disappeared and the upper 1/3 of the anterior wall was invaded; cervix was 5 cm × 4 cm, cauliflower-shaped and brittle; parametrial nodular thickening near the pelvic wall on the left side, slightly elastic, and parametrial cord-like thickening on the right side, with good elasticity; uterus was normal in size and poorly mobile. The pathology of cervical biopsy was moderately differentiated squamous cell carcinoma of the uterine cervix. The patient had no history of drug allergy and denied family history of hereditary diseases, tumor and autoimmune system diseases. Laboratory tests: AST 109 U/L, CK 1564 U/L, LDH 483 U/L, HBDH 477 U/L. Electromyography reported myogenic damage. Pathological examination of muscle biopsy: perifascicular atrophy was predominant with type II muscle fiber atrophy. Diagnosis: cervical squamous carcinoma stage IIb, DM. post-mounted radiotherapy A site 48 Gy, extracorporeal total pelvic radiotherapy DT 27 Gy, four field DT 21 Gy was given; oral prednisone 60 mg/day; intravenous methotrexate 15 mg/week, cisplatin 40 mg/week. Laboratory tests performed at 3 weeks of treatment: AST 84.7U/L, CK 679U/L, LDH 450U/L, HBDH 465U/L. Erythema edema, muscle weakness, muscle pain, swallowing difficulty and other symptoms were significantly relieved. The symptoms of erythema edema, muscle weakness, muscle pain and dysphagia disappeared. Low back pain appeared near the end of treatment, and nuclear bone scan considered 3rd lumbar vertebra and right femoral neck metastasis. Gynecological examination: vaginal mucosa was smooth with good dilatability; cervical 2cm×2cm in size, smooth; uterus was normal in size with good activity; right parametrium was soft and elastic, left parametrium showed fibrosis with slight thickening. Laboratory tests: AST 27.7U/L, CK 32U/L, LDH 294U/L, HBDH 286U/L. Still under treatment for cervical cancer bone metastases. Discussion After Stertz first reported DM combined with gastric cancer in 1916, reports of DM with malignant tumors gradually increased. the incidence of DM with malignant tumors ranged from 5 to 52%. At present, it is believed that the age of DM with tumor is generally older than 40 years, and the older the age, the greater the possibility of tumor. In this case, the age of the two patients is greater than 40 years old. The etiology of DM with malignant tumor is unknown, and autoimmunity is considered to be the main cause. Burnouf et al [3] suggested that skin necrosis is closely related to the associated tumor, and elevated muscle enzymes are also related to the tumor. In the present 2 patients, elevated myoenzymes were significantly associated with the development of cervical cancer, and local symptoms of skin lesions and cervical cancer subsided significantly with the decrease of myoenzymes during the treatment. Patients with DM who present with malignant erythema type often suggest cancer, and malignant erythema is characteristic for the diagnosis of DM with malignancy, and malignant erythema suggests a poor prognosis [4]. In the present 2 patients, both had malignant erythema. 1 died of cervical cancer liver metastasis 3 months after the end of treatment, and 1 developed cervical cancer bone metastasis near the end of treatment. There is a correlation between the development and regression of DM and malignancy. After tumor treatment (radiotherapy, chemotherapy, surgery), clinical observation of DM all improved with tumor control. Hu et al. summarized 45 patients with DM with nasopharyngeal carcinoma and found that combining radiotherapy with prednisone was not only effective, but also did not accelerate tumor metastasis. In our report, 2 patients with DM treated with adequate amount of glucocorticoids and immunosuppressants had unsatisfactory improvement of skin and muscle symptoms, but the skin and muscle symptoms and local lesions of the cervix disappeared after corresponding treatment with radiotherapy and chemotherapy. The prognosis of tumor patients with combined DM is poor. Yasuda [6] et al. reported a patient with hepatic neuroendocrine carcinoma with DM who died after 5 months of treatment. Choi et al. reported a patient with ureteral carcinoma with DM who died of interstitial pneumonia after 8 months, despite aggressive surgical treatment. In the present two patients, one case had disappeared from DM symptoms during treatment but died of cervical cancer liver metastasis 3 months after treatment, and one case had disappeared from DM symptoms near the end of treatment but developed cervical cancer bone metastasis. Therefore, for patients diagnosed with DM, the possibility of concomitant malignant tumor should be highly valued, and early detection, early diagnosis and early treatment should be achieved.