56-Year-Old With Cancer and Developing Rash

A 56-year-old woman presents to urgent care for a rash that developed on her hands, ears, and nose over the last couple of months. She has a recent diagnosis of esophageal cancer. On examination, hyperkeratotic plaques were seen on the palm and fingers, and scaly papules were seen on her helices and nose. Her nails displayed subungual hyperkeratosis, onychodystrophy, and onycholysis along with erythema and edema on her nail folds.

View the image below and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.