Pityriasis rubra pilaris (PRP) is a rare papulosquamous disorder of unknown aetiology. There are only three cases reported occurring coincident with internal neoplasia. We report a case of this disorder presenting as the initial manifestation of a previously undiagnosed malignancy with metastases in the liver. The primary tumour was not detected. The patient had a complete remission of his PRP with topical steroids alone, but died of the malignancy.