The palmar changes represent a cutaneous paraneoplastic sign known as tripe or velvet palm. It is highly associated with cancer (94% in some reports), most frequently with gastric adenocarcinoma or bronchogenic carcinoma.
Tripe palm — Tripe palm refers to a characteristic velvety thickening of the palms, with an exaggeration of normal skin markings . The term is derived from the resemblance to the stomach mucosa of ruminants (tripe).
Tripe palm is predominantly associated with gastric or bronchogenic cancer, although it has been rarely described in association with a variety of other malignancies . In one review, 94 percent of cases were associated with malignancy, and it was the initial presenting feature of a previously undiagnosed malignancy in 40 percent . Three-fourths of cases presented with concurrent acanthosis nigricans. Bronchogenic carcinoma accounted for 53 percent of cases with tripe palm only, while both gastric adenocarcinoma (35 percent) and pulmonary carcinoma (11 percent) were found in those with both tripe palm and acanthosis nigricans.
In view of the strong association of tripe palm with malignancy, a full cancer screening examination, with particular attention to the lungs and gastrointestinal tract, should be performed in adults with this condition.
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