Cowden syndrome. Early presentation, late diagnosis.

Cowden syndrome is a rare genodermatosis characterized by the formation of hamartomas in various organs and increased risk of malignancy. This disease has variable expression and often presents with subtle skin signs, which can be missed. We report a 39-year-old Saudi male who presented with acral keratoses of Cowden syndrome, and misdiagnosed and treated by many dermatologists as viral wart. We aim to increase awareness of Cowden syndrome among health care workers.