A 59-year-old woman with a history of smoking tobacco presented with a 5-month history of darkening of the skin on her palms. Velvety thickening on the palms and fingers was observed on physical examination.
Melissa Boyce, M.B., B.S.
University of the West Indies at Cave Hill, Bridgetown, Barbados
Cindy Flower, M.B., B.S., D.M.
University of the West Indies, St. Michael, Barbados
Funding and Disclosures
This article was published on July 23, 2022, at NEJM.org.