48-year-old male presents to his family physician with concerns over the discoloration of his neck. He first noticed it one month earlier, and has been trying to clean the area unsuccessfully. He is otherwise well, though he notes that his clothes fit more loosely now than they did a year ago. Examination reveals hyperpigmented velvety plaques on the neck and both axillae. His BMI is 22 and an A1C is 5.1%. Given the rapid appearance of this hyperpigmentation with no evidence of insulin resistance, an occult malignancy is considered. Which of the following malignancies is most commonly associated with this presentation? A. Gastric adenocarcinoma B. Hepatocellular carcinoma C. Lung adenocarcinoma D. Pancreatic adenocarcinoma Post your guess here, then check Figure 1 to see if you're right! Explore cases, quiz yourself, and solve medical mysteries along with thousands of other medical professionals around the world on Figure 1, the free app where doctors expand their clinical knowledge.