This case report describes a 44-year-old Haitian male smoker who presented with rapid-onset progressive nail changes and hand eruptions, accompanied by a chronic six-month cough. Physical examination revealed extensive nail abnormalities including paronychia, anonychia, and nail bed hyperkeratosis, along with erythematous keratotic papules on the ears and hyperkeratotic plaques on the palm. While initial laboratory testing was unremarkable, chest imaging revealed a substantial mass in the left upper lobe suggestive of pulmonary malignancy. The patient was diagnosed with Acrokeratosis Paraneoplastica (Bazex syndrome), a rare paraneoplastic dermatosis that typically presents with psoriasiform eruptions and nail changes as early manifestations of underlying malignancy, particularly of the upper aerodigestive tract.