A 73-year-old woman presented with itchy, itchy and painful lesions on her hand, which looked like it consisted of rumen palms. It was later revealed by doctors that her velvety palms turned out to be a rare sign of lung cancer.
The patient, who was from Brazil, consulted a dermatology clinic with painful and itchy lesions on her hands and was diagnosed with rumen palms. Her hands resembled tripe, which is a rippling gastric mucosa in animals, such as pigs, sheep, and cows.
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“Physical examination revealed a sharp delineation of the folds in the lines of her hands, in addition to a velvety appearance of palmar surfaces and ridges of the skin,” the doctors wrote in the case report.
The case, which was published in The New England Journal of Medicine, showed that the patient is a heavy smoker with a smoking history of 30 pack years. She had had a chronic and persistent cough for the past year and had lost about 11 pounds in four months. All these signs and symptoms indicated that she might have cancer.
Velvety Palms, Denis Miyashiro, MD, and Jose A. Sanches, MD, Ph.D. Image Credit: The New England Journal of Medicine Publisher: Massachusetts Medical Society
The woman underwent a battery of tests, including computed tomography scans of her chest, abdomen and pelvis, and revealed she has adenocarcinoma, a type of lung cancer. On her CT scan, there is an irregular lump in the left upper lobe of the lungs. She also had enlarged mediastinal lymph nodes.
Adenocarcinoma is a cancer that forms in the glandular cells in various body locations, such as the colon, lung, prostate, breast, and pancreas.
“Rental palm lesions may resolve with treatment of underlying cancer; however, the lesions in this patient did not regress with chemotherapy or with the application of 10 percent urea-containing ointment,” the doctors said.
The doctors reported that six months after the patient consulted the dermatology clinic, her cancer had progressed and when the case report was written, the woman was on her second round of chemotherapy. However, it is not known whether the second phase of chemotherapy was successful in fighting cancer.
The doctors reiterate that even skin changes can indicate the presence of underlying cancer or malignancy. It is important to note that his rare skin condition, rumen palms, is serious and the patient should seek medical attention as soon as possible.
“Therefore, all patients with rumen palms should be evaluated with a full diagnostic workup for an associated malignancy, especially lung or gastric carcinoma,” the doctors added.
Rumen palms and cancer link
Rumen palms, also known as acanthosis palmaris or acquired pachydermatoglyphia, are characterized by thickened velvety palms that resemble rumen. About 90 percent of rumen palms are linked to internal malignancy.
First described in 1977 by a London dermatologist, Dr. Jacqueline Clarke, rumen palms have a thick and mossy appearance. The condition is very rare; therefore, there is only a limited amount of research and evidence left.
Velvety surfaces on the palms are not always itchy or painful. While the exact cause of the skin changes is still unknown, the ridges on the hands have been linked to an internal malignancy or cancer.
The exact cause of rumen palms developing is still unclear, but experts say it stems from underlying cancer, releasing substances that stimulate palmar skin cells to proliferate.
The most common cancers associated with rumen palms are stomach cancer (35 percent) or lung cancer (11 percent).
What is lung adenocarcinoma?
Lung adenocarcinoma is a type of lung cancer, which is considered a non-small cell lung cancer. This type of lung cancer accounts for more than 30 percent of all lung cancers and about half of all non-small cell lung tumors.
The tumor usually develops in glands that secrete mucus and, in the alveoli, the small airway sacs that pump air in and out of the lungs, and where gas exchange takes place.
The most common signs and symptoms are persistent cough, chest pain, shortness of breath, raspy voice, unexplained weight loss, and coughing up blood.
Miyashiro, D., and Sanches, J. (2019). Velvety soft palms. The New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMicm1902529?query=TOC