Palmar and Plantar Pits, More than Just Viral Warts

A 40-year-old woman with a family history of gastric, pulmonary, and endometrial cancers (parents and grandparents) was referred to our institution with a 3-year history of progressive pruritus with palmar and plantar papules. On physical examination, there were keratotic yellowish pinpoint papules on the hands (Figure 1) and yellowish keratotic plaques and papules on the plantar pressure points (Figure 2). The diagnosis of punctate palmoplantar keratoderma was confirmed histopathologically (Figure 3), and treatment was initiated with 30% urea cream, which proved helpful. Molecular studies were requested, which documented a variant in the