«вельветовые» ладони

A 73-year-old woman who had a smoking history of 30 pack-years presented to the dermatology clinic with pruritic and painful lesions on the palms of her hands that had first appeared 9 months earlier. She reported a cough that had been present for 1 year and a weight loss of 5 kg over the past 4 months. Physical examination revealed sharp demarcation of the folds in the lines of her hands in addition to a velvety appearance of palmar surfaces and ridging of the skin (Panel A). This condition, known as tripe palms, is closely associated with cancer, particularly lung and gastric cancer. Computed tomography of the chest (Panel B), abdomen, and pelvis was performed and revealed an irregular nodule in the left upper lobe and enlarged mediastinal lymph nodes. Examination of the biopsy specimens of the nodule and mediastinal nodes confirmed the diagnosis of adenocarcinoma. Chemotherapy and radiation therapy were initiated. Tripe palm lesions may resolve with treatment of the underlying cancer; however, the lesions in this patient did not regress with chemotherapy or with the application of 10% urea-containing ointment. Six months after presentation, the cancer had progressed, and the patient began a second-line chemotherapy regimen.Denis Miyashiro, M.D. Jose A. Sanches, M.D., Ph.D. Universidade de São Paulo, São Paulo, Brazil November 14, 2019 N Engl J Med 2019;