患者男,76岁,因皮肤色素沉着2年余并进行性吞咽困难半年入院.体检:呈恶病质状。左锁骨上淋巴结蚕豆大小,不活动。左肺上部呼吸音较弱。剑突下扪及包块,质硬,触痛明显.肝肋下6cm,质地中等,触痛,表面有结节。前列腺稍肥大。皮肤科情况:面部、颈部、双肘关节伸侧、腋窝、乳晕,腹股沟、外生殖器、会阴等处皮 The patient male, 76 years old, was hospitalized for more than 2 years due to skin pigmentation and had difficulty swallowing. The physical examination showed a cachexia. Left supraclavicular lymph node size, inactive. The upper left lung breath sounds weaker. The xiphoid ridges and masses are hard and tender. The liver is 6 cm below the ribs, and the texture is medium, tender and nodules on the surface. The prostate is slightly enlarged. Dermatology: Facial, neck, double elbow extension, axilla, areola, groin, external genitalia, perineum, etc.