Rare skin condition in a smoker
This article describes the case of a 59-year-old woman with a history of smoking tobacco diagnosed with triple palms. The patient complained of skin darkening on her palms that had appeared 5 months ago. She did not complain of any other symptoms. Physical examination was significant for the thickening of the skin on the palms and fingers. Other findings included an accentuation of the fingerprint ridges. The findings are consistent with the diagnosis of acanthosis palmaris. Additionally, the shortening of the small fingers on both hands was also evident. However, this finding was considered a normal variation.
There were no signs of clubbing or acanthosis nigricans. Doctors further referred the patient for computed tomography of the chest with concern for underlying cancer. Computed tomography of the chest was significant for a mass in the upper lobe of the right lung. The mass was biopsied and sent for histopathological analysis. Findings showed an undifferentiated carcinoma. The patient was referred for a right upper lobectomy which showed a moderately differentiated and invasive lung adenocarcinoma. The findings further showed that the adenocarcinoma had metastasized to the regional lymph nodes. However, because of limited resources, the tumour could not be tested for mutations. Treatment included 5 months of chemotherapy after which the skin changes had resolved.
Triple palms
Triple palms are a rare skin condition characterised by thickening of the skin that affects the palms of the hands and soles of the feet.
The term triple palms come from the condition’s resemblance to the stomach lining of some animals. Triple palms are a type of paraneoplastic dermatopathy that is commonly seen in patients with adenocarcinoma of the lungs and gastrointestinal tract. It is frequently associated with internal malignancy. Treatment includes chemotherapy after which the skin changes resolve, as with this case. It is also referred to as chanthosis palmaris or acquired pachydermatoglyphia. The skin condition shares the same underlying genetic basis as cancer.
Source: NEJM
