Snap Shot A 55-year-old woman presents to a dermatologist with ulcerative skin lesions on her legs and buttocks. A diagnosis of migratory necrotizing skin erythema is made. A CT scan of the abdomen is performed. Introduction An alpha-cell tumor of the pancreas Presentation Symptoms non-specific may include skin manifestions Physical exam non-specific migratory necrotizing skin erythema Evaluation Labs increased glucagon level hyperglycemia Treatment Operative resection of tumor