Pemetrexed (Alimta™) is used frequently for the treatment of lung cancer and is associated with various types and grades of cutaneous side-effects. We report here one patient who presented with asymptomatic hyperpigmentation of the skin, localized on the palms of the hands and the soles of the feet after administration of pemetrexed for lung cancer despite receiving standard pre-medication. This type of skin toxicity was completely reversible after withdrawal of the drug (without pharmacologic intervention) and has to our knowledge not been reported before.