A 73-year-old woman presents with a three-month history of multiple scaly, reddish patches on both hands and feet. She has also lost seven kilograms of weight during the same duration. Further questioning reveals anorexia and mild dysphagia to solids alone, also for the same time period.

Her medical and dermatological histories are unremarkable. Her surgical history is only significant for an uncomplicated vaginal hysterectomy performed at age 63. She is a heavy smoker, with around 50 pack-years of exposure.