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Pre-morbid skin changes in patients with cancer: Using 'Welam's sign' as a new prognostic marker?

Identification of the imminently dying patient can be a complex and difficult process, especially in a frail and elderly population with malignancy. The Liverpool Care Pathway utilizes a number of identification criteria for end-of-life care, but additional prognostic physical signs may be useful. This article describes specific skin changes not previously featured in the literature in four patients at end of life with malignancy, and discusses the potential use of this as a prognostic indicator.