Skin rash and Weight Loss

65 year old cab driver with history of chronic hepatitis C and eczema comes in to the office with a non-pruritic rash that has been progressing over the past few months. It involves his arms, back and chest. He denies any associated systemic symptoms. He denies any exposure to new chemicals, topical or systemic. His last travel to his home country, Ghana, was about a year ago. He drinks liquor on a daily basis. He is in a monogamous relationship with his girlfriend. His medications include Sildenafil and mometasone ointment prn. Review of systems is significant for an unintentional 30 lb wt loss since his last office visit a year ago. He has diffuse, hyperpigmented coalescing macules on his arms, trunk and back with fine superficial scales. He also has tenderness involving the LLQ.

Which of the following is the most likely diagnosis?

A. Pityriasis Versicolor
B. Pityriasis Rotunda
C. Tinea corporis
D. Eczema
E. Psoriasis

On follow up next week, the patient reports some improvement with the treatment prescribed for the skin rash. Blood work reveals a platelet count of 77, AST: 95, ALT: 70, ALP: 150. Abdominal CT shows multiple hepatic masses. EGD and colonoscopy were normal. PET scan showed multiple hepatic masses, the largest one being about 5 cm, which had abnormal uptake of FDG (SUV: 7.4). Alpha feto protein was 2024 (Nml <6).

Which of the following dermatological pathology is most common in primary HCC?

A. Pityriasis Versicolor
B. Pityriasis Rotunda
C. Tinea corporis
D. Eczema
E. Psoriasis