A woman who went to see a doctor about a strange skin condition on her hands got a nasty shock when it turned out she had lung cancer. According to a summary of the case in the New England Journal of Medicine, the 73-year-old was suffering from a rare condition called tripe palm, which is nearly always an indicator of some kind of cancer.

Doctors tending to the patient noticed that her palmar surfaces had “a velvety appearance,” with “sharp demarcation of the folds in the lines of her hands.” The woman also complained that her palms were itchy and painful, but couldn’t have expected the news that she was about to receive.

Tripe palm, which is so-called because the skin of the palm resembles pig tripe, is rarely seen in the absence of cancer, which led doctors to suspect that the woman may have a tumor somewhere in her body.

When she revealed that she had been smoking the equivalent of 20 cigarettes a day for the past 30 years, had suffered from a persistent cough for about a year, and had lost 5 kilograms (11 pounds) in just four months, lung cancer suddenly seemed a real possibility.

Sure enough, further tests revealed “an irregular nodule in the left upper lobe and enlarged mediastinal lymph nodes,” resulting in a diagnosis of a type of cancer called adenocarcinoma.

Often, symptoms of tripe palm disappear when cancer is treated, although in this case it persisted as both chemotherapy and the use of an ointment containing urea failed and the cancer progressed.

Six months later, the woman began a second chemotherapy regimen, though no more details are given as to her current condition.