A 79-year-old woman presented with 10 kg unintentional weight loss, anorexia, fatigue and cough over 3 months on a background of 50 pack-years smoking history. Physical examination revealed digital clubbing and velvety thickened palms with accentuated skin markings consistent with tripe palms (Figure, A and B). A whole-body positron emission tomography/computed tomography scan revealed a 6.4 cm left upper lobe lung mass intensely fludeoxyglucose avid. Subsequent computed tomography scan-guided biopsy revealed KRAS-mutant adenocarcinoma. Tripe palms or acanthosis palmaris is a rare manifestation of internal malignancy, most notably lung or gastric cancer.1 The patient declined further treatment and opted for palliative care.
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