A 69-year-old man presented with a 3-year history of an asymptomatic keratoderma that affected both palms. His medical history was notable for hepatic cirrhosis and hepatocellular carcinoma, which had been diagnosed 2 years earlier and for which he was undergoing chemoembolization, with good response. He had no history of skin diseases, local medication use, prolonged solar exposure, or radiation or arsenic exposure, and no other family members were affected.
Physical examination revealed multiple, spiny and filiform horny projections that were strictly limited to the palms. The individual lesions were skin-colored, approximately 0.8 mm in diameter and 3 mm in length, firmly attached at the base, and not easily removed (Figure 1 and Figure 2). A 4-mm punch biopsy specimen was obtained from the affected area for microscopic examination (Figure 3).
Blanes M, Carnicer F, Botella R, Pastor N, Peiró FM. Filiform Horny Projections on the Palms of a 69-Year-Old Man—Quiz Case. Arch Dermatol. 2006;142(2):235-240. doi:10.1001/archderm.142.2.235-d