A 65-year-old man presented with a 12-month history of gradual darkening of his neck. He also reported a progressive increased right side mandibular mass and a weight loss of 4 kg over 3 months. He smoked for 50-pack years. His past medical and familial histories were unremarkable. On physical examination, slight velvet pigmented plaques of the neck and ipsilateral cervical lymphadenopathy (Fig. 1) were observed. Computed tomography showed a right lung mass with cervical lymph nodes and diffuse liver metastasis.
