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Acanthosis Palmaris: A Rare Paraneoplastic Manifestation of Non-Small-Cell Lung Cancer.

Case Report A 56-year-old woman received treatment for advanced lung adenocarcinoma. She had been diagnosed with brain metastases and a left upper lobe primary tumor after presenting with headaches. She underwent whole-brain radiotherapy and was treated with platinum-based chemotherapy followed by maintenance pemetrexed. She progressed after six cycles of pemetrexed and was started on programmed death-1 inhibitor therapy with nivolumab. Her performance status was declining, and she did not appear to have a good clinical response after four cycles. Early in the courseof her chemotherapy treatment, she was noted to have marked clubbing, as well as ridged, velvety palms, theappearanceofwhich is consistentwitha diagnosis of acanthosis palmaris (Fig 1). This became even more pronounced during her second-line treatment with nivolumab. Because of her advanced malignancy and strong basis for a clinical diagnosis, biopsy was not pursued. She subsequently deteriorated rapidly, being admitted via the emergency department with type 1 respiratory failure. Reversible causes, including infection and pulmonary embolus were excluded, but a computed tomography scan was consistent with dramatic radiologic progression of her cancer. She was counseled regarding a symptom-focused approach to care and was treated supportively with supplemental oxygen. She passed away several days later.