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JAMA Oncology Clinical Challenge
March 14, 2019

Widespread Thickened, Verrucous, Hyperpigmented Plaques in a Woman With Weight Loss

Author Affiliations
  • 1Department of Dermatology, Peking University First Hospital, Beijing, China
  • 2Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Beijing, China
JAMA Oncol. 2019;5(7):1055-1056. doi:10.1001/jamaoncol.2018.7153

A 30-year-old woman presented with a 4-month history of widespread thickened, verrucous, hyperpigmented plaques distributed symmetrically on her body, especially on the axillae (Figure 1A), anogenital region, inguinal skin, and both palms, with slight itching. The verrucous plaques also involved the conjunctiva, lips, and gingiva (Figure 1B). The patient had experienced a weight loss of 6 kg during the last 3 months. Within the last month, the patient’s thyroid became enlarged, and she developed anorexia and abdominal discomfort. Laboratory test results revealed remarkably elevated levels of carcinoembryonic antigen, carbohydrate antigen 19-9, carbohydrate antigen 125, tissue polypeptide antigen and carbohydrate antigen 242. Biopsy specimens of lesions on the axillae and lips both revealed a papillary structure with hyperkeratosis. An endoscopic examination and computed tomographic scan of the abdomen were performed.

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