Acrokeratosis paraneoplastic (Bazex syndrome) is a rare, but distinctive 
paraneoplastic dermatosis characterized by erythematosquamous lesions located at 
the acral sites and is most commonly associated with carcinomas of the upper 
aerodigestive tract. We report a 58-year-old female with a history of a 
pigmented rash on her extremities, thick keratotic plaques on her hands, and 
brittle nails. Chest imaging revealed a right upper lobe mass that was proven to 
be small cell lung carcinoma. While Bazex syndrome has been described in the 
dermatology literature, it is also important for the radiologist to be aware of 
this entity and its common presentations.