NEJM images: 55-year-old man with metastatic squamous-cell lung cancer Hx& 6-wk Hx firm, painful swelling RToe1 & RDIP3 w/ ulceration. Xray showed lytic lesions due to acrometastases - rare bony metastases distal to elbow or knee, that may may mimic gout or osteomyelitis https://t.co/1Fh1Cp9dm9