Necrolytic migratory erythema: a fortuitous diagnosis

A woman in her late 60s presented with widespread, itchy, dark lesions over her trunk and legs for 1 month. Initially, she was managed as nutritional dermatitis and experienced partial improvement. However, her condition worsened over 2 months, characterised by aggravated skin lesions, new-onset diabetes and a 12 kg weight loss. On suspicion of necrolytic migratory erythema (NME) secondary to glucagonoma, the contrast-enhanced CT (CECT) abdomen revealed a primary pancreatic lesion with multiple liver metastases. The diagnosis of neuroendocrine tumour was confirmed by liver biopsy with immunohistochemistry, and stage 4 status was revealed by fluorodeoxyglucose-positron emission tomography CT. Following 6-monthly octreotide injections and nutritional and supportive care, her skin lesions completely resolved. This case emphasises the significance of recognising NME, a rare and often misdiagnosed dermatological condition, as it may signify an underlying occult neuroendocrine pancreatic malignancy. Early recognition is crucial for the timely initiation of appropriate management.