Tripe palms, sign of Leser-Trélat, and florid cutaneous papillomatosis are paraneoplastic entities most commonly associated with aggressive tumors. Recognition of cutaneous paraneoplasia in this case led to the detection of an occult liver malignancy in a 54-year-old woman who presented with a six-month history of diffuse thickening of palmar skin and an eruption of intensely pruritic hyperpigmented papules and plaques on her neck, abdomen, and extremities. Biopsy from the palm, thigh, and axillary lesions were consistent with tripe palms, seborrheic keratosis, and florid cutaneous papillomatosis, respectively. This patient was asymptomatic for involvement of the gastrointestinal system but had elevated serum CEA and CA 19-9 and was positive for anti-Hbs and anti-HBc. Triple-contrast triphasic scan of the abdomen revealed multiple hepatic masses and persistent sigmoid wall thickening and narrowing. Liver biopsy was positive for carcinoma cells. Therefore, an exhaustive search for the underlying neoplasia should be undertaken even in asymptomatic cases as paraneoplastic entities can be the initial and only physical clues to an underlying malignancy and early detection can be lifesaving.

Human ; Female ; Middle Aged ; Abdomen ; Abdominal Cavity ; Biopsy ; Colon, Sigmoid ; Keratosis, Seborrheic ; Liver ; Neoplasms ; Thigh

Healing or restoration to wholeness is most likely to occur in a satisfied patient. One valid measure of the quality of care is patient satisfaction and at the core of this is a good physician-patient relationship.

Psychology ; Physician-patient Relations