Acquired Spiny Keratoderma in an Older Adult: Implications for Malignancy Surveillance and Longitudinal, Cost-Conscious Care

Abstract We present a case of a 72-year-old man with a 30-year history of palmar spiny keratoderma and prior unprovoked deep vein thrombosis. Lesions demonstrated partial improvement with topical keratolytics and retinoids, though treatment adherence was limited by medication cost, necessitating reliance on mechanical exfoliation and over-the-counter alternatives. Spiny keratoderma is a rare skin disorder featuring small keratotic projections from the palms and may also affect the soles. While often perceived as a benign dermatologic condition, the acquired form has been reported in association with internal malignancy, particularly in older adults. Despite these associations, no formal guidelines exist for cancer surveillance or long-term management. Acquired spiny keratoderma in older adults may represent a cutaneous marker of systemic disease and should prompt consideration of systemic evaluation. Given the patient’s history of acquired keratoderma and prior unprovoked venous thromboembolism, both of which have been associated with underlying malignancy, he represents a patient at elevated risk who warrants continued clinical monitoring. Continued age-appropriate malignancy surveillance and attention to socioeconomic barriers are essential components of patient-centered care.