Digital acrometastases as first sign of hepatocellular carcinoma.

Digital acrometastases as a primary presentation of hepatocellular carcinoma (HCC) is rare. A 66-year-old man with no history of malignancy presented to the plastic surgery department with two skin lesions, one on the bridge of his nose and one on distal phalanx of left little finger. A working diagnosis of cutaneous metastases was made. Immediately prior to admission for excision of these lesions he was admitted with right upper quadrant pain and a jaundiced discolouration of the skin. The lesions were excised as planned and histopathological examination revealed metastatic HCC. A subsequent magnetic resonance imaging showed a lobulated mass consistent with primary HCC.