What Do Velvety Palms Indicate?

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Image Source: The New England Journal of Medicine

The diagnosis of cancer may not always be as straightforward as pinpointing a mass in the body. A malignancy may show signs which if followed lead to a diagnosis.

The signs can be anything, depending upon the type of malignancy and the organ involved, the signs and symptoms indicating the presence of malignancy are quite variable.

Here is a case presentation:

A 73-year-old woman with 30 pack-years smoking history presented to the dermatology clinic with a 9-month history of painful, itchy lesions on the palms of her hands. The past medical history was insignificant except for a cough that had been present for 1 year and a 5-kg weight loss in the past 4 months.

On examination of her hands, sharply delineated folds were observed in the lines of her hands and the palm had a velvet-like appearance (Panel A).

Such palms are called tripe palms, acanthosis palmaris, and acquired pachydermatoglyphia. The name ‘tripe’ is attributable to the velvety appearance, similar to the stomach lining of a cow, pork, or sheep.

The examination of such palms, although a rare finding, indicates malignancy in 90 % of the cases, usually preceding the diagnosis of cancer. The most common malignancies associated with tripe palms are lung and gastric carcinoma.

Therefore, after observing tripe palms in the patient, computed tomography of the chest (Panel B), abdomen, and pelvis were performed to rule out malignancy.

The results revealed an irregular pulmonary nodule in the left upper lobe of the lung. The mediastinal lymph nodes were also enlarged.

Specimens were collected from the pulmonary nodule and the mediastinal lymph nodes for histopathological evaluation, which confirmed the diagnosis of adenocarcinoma. Treatment was initiated. The patient was started on chemo- and radiotherapy along with the application of 10% urea-containing ointment. None of the treatment worked and the tripe palms persisted. After six months of presentation, the malignancy had progressed, so a second-line chemotherapy regimen was initiated. 

References

Denis Miyashiro, M.D., and Jose A. Sanches, M.D., Ph.D. (2019, November 14). Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1902529

Ngan, V. (2005). Tripe palms. Retrieved from DermNet NZ: https://dermnetnz.org/topics/tripe-palms/

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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