A patient with leonine facies and occult lung disease.

velvety hyperpigmentation in the neck ( fig. 2 ), axillae and the groin. Furthermore, the dorsa of the hands had brown thickened skin with a pebbly appearance ( fig. 3 ) and the palms showed rugose thickening with more pronounced skin markings ( fig. 4 ). His general and systemic clinical examination was otherwise unremarkable. What are the clinical diagnoses and, more importantly, which pulmonary affliction is associated with these conditions? A 70-year-old male patient presented with a 2-week history of a skin eruption involving the face, neck, axillae, groin, palms, and dorsa of the hands. He had no systemic complaints and no significant past medical or surgical history. He was a smoker (30 pack years), and had no specific occupational exposure. On examination he was found to have leonine facies ( fig. 1 ), with coarse facial features and grey velvety plaques on pressure areas of the face. He was also noted to have Received: July 1, 2009 Accepted after revision: August 10, 2009 Published online: October 24, 2009