skip to main content

Paraneoplastic Dermatosis — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

HardSkin CancerParaneoplastic DermatosisSCE Dermatology

A 62-year-old develops abrupt velvety rugose thickening of both palms, acanthosis nigricans and six kilograms of unintentional weight loss. There is no previous keratoderma. What is the most appropriate response?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Investigate occult malignancy, particularly gastric or lung carcinoma

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · B = shown as D

E is correct. Tripe palms are an acquired velvety exaggeration of palmar dermatoglyphics strongly associated with internal malignancy; gastric and lung cancers are prominent associations. Abrupt onset, acanthosis nigricans and weight loss strengthen the paraneoplastic interpretation. Investigation should be guided by history, examination, age-appropriate pathways and relevant imaging or endoscopy. Inherited keratoderma usually begins earlier and often has a family pattern. Keratolytics may improve texture but cannot address the systemic cause. Nutritional deficiency and pityriasis rubra pilaris can enter a broader differential, but neither accounts as well for this acquired constellation.

Reference: DermNet tripe palms: https://dermnetnz.org/topics/tripe-palms