Acral injury as first manifestation of a metastatic adenocarcinoma of the colon.

A 56-year-old woman suffered from a painful lesion in the distal phalanx of the left second finger for two months that affected both the skin and nail (Fig. 1). At the same time she presented also with hairless plate lesion in the occipital region (Fig. 2). She received antibiotics without improvement. Consequently, a biopsy was taken from the nail lesion. Histopathology showed nail infiltration from a mucus secreting adenocarcinoma being suggestive of metastasis from intestinal origin. Further investigation in the Gastroenterology Department discovered by means of colonoscopy a stenosing neoplasia at the hepatic flexure. Cranial and body CT revealed also skin, brain, lung and liver metastases together with peritoneal carcinomatosis. Palliative measures were undertaken. The patient passed away three months later.