Palmar petechiae (black spots on palms) in terminally ill patients with cancer: a sign of impending death.

Certain physical signs can be useful in predicting impending death. We present four terminally ill patients with malignancy who developed petechiae on their bilateral palms and fingers during the week prior to their deaths. Drug-induced eruption, injury, and mechanical stimuli were thought to be unlikely causes of the petechiae. While the phenomenon has not previously been reported, we speculate palmar petechiae may be a clinical cutaneous sign of systemic deterioration in terminally ill patients.