Mildly Pruritic Skin Eruption in 44-Year-Old Taiwanese Immigrant


Several years ago, a 44-year-old nonsmoking Taiwanese immigrant to the United States sought medical attention for the skin eruption depicted. This disorder had been present since he was 25; it was mildly pruritic, and involved the scalp, elbows, knees, and dorsal hands (16% of body surface area). He had also noted abnormal fingernails, with onycholysis and pitting having been present for about 5 years. The rest of the physical examination was unremarkable except for mild hypertension (158/92 mm Hg). Pertinent findings from a recent comprehensive laboratory panel included new findings of fasting hyperglycemia and an elevated hemoglobin A1c. He now presents to the dermatologist for a routine semi-annual follow-up visit, his rash well controlled using topical corticosteroids and intermittent narrow-band UVB phototherapy. As incidental complaints, he notes an involuntary 35-pound weight loss and increasing fatigue. He is ultimately referred to the oncologist for further evaluation and care.

The most likely primary site of this patient's malignancy is the...?

A. Lung
B. Bone marrow
C. Colon
D. Retina
E. Prostate