 an 82-year - old japanese man was referred for detailed examination of hyperkeratotic erythematous plaques on his palms and soles for 6 months . 
 two weeks before his first visit , he had undergone lung lobectomy for right lung squamous cell carcinoma ( scc ) . 
 laboratory findings showed elevations of eosinophil counts , serum ige , thymus and activation - regulated chemokine , scc antigen , and soluble interleukin-2 receptor levels . 
 histological results of a skin biopsy involving the left palm showed psoriasiform dermatitis . before lung lobectomy , the hyperkeratotic erythematous plaques on the palms and soles and the erythemas on the trunk and extremities were difficult to treat with topical steroids . 
 after lobectomy , the skin symptoms dramatically and rapidly subsided with topical steroids . 
 therefore , we diagnosed bazex syndrome ( bs ) , also known as acrokeratosis paraneoplastica , as a paraneoplastic cutaneous disease in lung scc . 
 the mild eosinophilia subsided and levels of scc antigen , ige , and soluble interleukin-2 receptor were reduced . 
 bs is a paraneoplastic cutaneous disease characterized by acral psoriasiform lesions associated with an underlying neoplasm . in a previous report 
 , a shift to the th2 immune condition was found in patients with non - small cell lung cancer , as shown in our patient . 
 epidermal growth factor receptor ( egfr ) is also known as tumor growth factor- receptor ; it is increased in psoriatic keratinocytes . in our case 
 , egfr expression increased in lesional keratinocytes 2 weeks after surgery and decreased 4 weeks after surgery . 
 we speculate that a shift to th2 immune reactions in lung scc may be the pathogenesis of bs , whereby lesional keratinocytes highly express egfr in parallel with disease activity . 
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