September 2004





History: A 63-year-old white woman presented with progressive, worsening scaly rash affecting the fingers, hands, toes, feet, and ears. She first noticed 8 months ago that her fingernails and toenails were getting dystrophic. Shortly afterwards, her toes, fingers, and distal aspect of both hands and feet became scaly and red. Eventually, her ears were involved with scales and redness.

Physical examination: Dystrophic changes affecting all fingernails and toenails were noted. There were scaly, violaceous patches on all fingers, toes, and distal aspect of both hands (Fig. 1) and feet. She also hsd scaly,violaceous patches on the helices of both ears. (Fig.2)

Chest CT:
Very large mass in the superior mediastinum that appears to arise from the esophagus. There is also concentric thickening of the distal esophagus distinct from the large tumor.

Two different areas of constriction in the esophagus were found. Biopsies of these areas showed squamous cell carcinoma of the esophagus.


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