When a 73-year-old patient visited a dermatological clinic for painful lesions on her hands, it was just one of many signals that everything was wrong with this woman's poor health.
She had been coughing for about a year and had lost 5 pounds (11 pounds) in the last four months alone. Gloomy symptoms for anyone, but especially an adult smoker who admitted to going through a pack of cigarettes for 30 years.
Yet, it was not these warning signs that brought her to the clinic, but rather the strange scars on her hands and the pain and itching that she was experiencing.
"Physical examination revealed a sharp distinction between creases along the lines of her hands in addition to the velvety appearance of palmar surfaces and the appearance of skin." her doctors wrote in a case report.
velvety palms like this one are a rare medical condition known as "tripis veins" , because of their resemblance to the tingling gastric mucosa of cows, pigs or sheep.
Sometimes called acanthosis palmaris, such trip palms fall into the categories of skin disorder in which the skin is abnormally darkened due to hyperpigmentation (such as acanthosis nigricans) or abnormally thickens (as in palmodermental).
The velvet surfaces that are obtained are not always itchy or painful. Although the exact cause of the skin changes is unknown, the individual spines are usually associated with some internal malignancy, with over 90 percent of cases including a cancer diagnosis in one study.
Most often, the trip palm – which may appear among other skin abnormalities – is coincident with lung cancer or stomach cancer. In the case of this 73-year-old patient, a woman from Sao Paulo, Brazil, lung irregularities were detected by computed tomography.
The following biopsy confirmed the diagnosis of adenocarcinoma and underwent chemotherapy and radiation therapy.  There is no known cure for thrips of the palms, but as explained by the physicians of the patient, the cure of the disease that causes them to occur in the first place may have the potential to disappear the skin symptom, though not always.
"Lesions of palm thrips may resolve with treatment for underlying cancer," the doctors note, "however, the lesions in this patient did not regress with chemotherapy or with the administration of 10% urea containing urea."
More significantly, six months after the patient first presented to the skin clinic, doctors observed that her cancer had progressed and at the time of writing her case report, the woman began a second round of chemotherapy.
It is not known whether this cond round was successful or not, but the experience of the patient shows how serious this rare disease of the skin can be and how seriously we should take it when it occurs.
"The important thing is that in over 40 percent of patients, triple palms are the main characteristic of an undiagnosed previously malignant disease," scientists note in a 1989 study.
"Therefore, all patients with trips palms should be evaluated with complete diagnostic treatment for a related malignancy, in particular lung or stomach cancer. "
The findings were reported in The New England Journal of Medicine .