Purpuric lesions can be caused by embolization from heart valves which are the site of nonbacterial thrombotic endocarditis (NBTE) a malady widely held to be a terminal event and of necroptic interest only. Embolic phenomena to various organs mainly brain, spleen, and kidneys may, however, precede the symptoms of cancer which commonly are associated with NBTE. Biopsy of purpuric lesions will disclose their embolic origin.
GOLDSTEIN RS, ZAK FG. Skin Lesions Caused by EmbolizationFrom Heart Valves With Nonbacterial Thrombotic Endocarditis. Arch Dermatol. 1966;93(5):585–587. doi:10.1001/archderm.1966.01600230089023