A woman who visited her doctor with a bizarre rash on her hands was shocked to learn it was a sign of deadly cancer.
The 73-year-old from Brazil sought medical advice after developing painful and itchy marks on the palms of her hands.
She told doctors that she had been living with the condition for nine months, had been nursing a persistent cough for a year and had begun to lose weight, dropping 5kg in four months.
The woman admitted to smoking heavily for 30 years.
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The case was reported in the New England Journal of Medicine, where doctors revealed that: "Physical examination revealed sharp demarcation of the folds in the lines of her hands in addition to a velvety appearance of palmar surfaces and ridging of the skin."
The condition is known as "tripe palms" because of the way the skin resembles the rippled stomach lining of sheep, cows and pigs.
The doctors said: "This condition, known as tripe palms, is closely associated with cancer, particularly lung and gastric cancer."
Doctors ordered CT scans, which revealed abnormalities on her lungs and a biopsy confirmed that she was fighting a cancer known as adenocarcinoma.
The woman was treated with chemotherapy and radiation but sadly did not respond to the treatment.
Six months after she first went to the doctors, the cancer had progressed and another round of chemotherapy was started, but doctors didn't reveal the results in their report.