A man in his 60s presented in consultation from his oncologist for a 3-week history of a pruritic eruption on his back in the setting of stage IV, progressive, neuroendocrine pancreatic cancer. He had undergone numerous chemotherapeutic regimens over the past 3 years, all of which had failed. For the past 4 months he had been receiving oral etoposide (daily for the first 3 weeks of each 4-week cycle), daily pancrelipase, and monthly octreotide acetate intramuscular injections. He denied the use of heating pads but admitted to sitting on the hearth, directly in front of his fireplace, for long periods because of the cold weather and chills presumably from his underlying malignant neoplasm. He acknowledged a mild, untreated seasonal rhinitis but otherwise had enjoyed good health prior to his cancer diagnosis. Physical examination revealed a large, reticulated, erythematous plaque with micaceous and silvery scale localized to the mid-back (Figure, A). A punch biopsy was performed (Figure, B-D).
Tschetter AJ, Stone MS, VanBeek MJ. A Striking, Localized Eruption. JAMA Dermatol. 2014;150(11):1229-1230. doi:10.1001/jamadermatol.2014.2179