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A man in his 80s with Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma was started on combination therapy with atezolizumab, an immune checkpoint inhibitor, and bevacizumab, a vascular endothelial growth factor (VEGF) inhibitor. Three days after the first cycle, he developed umbilicated papules with a central adherent keratotic plug on the head, trunk and extremities ( figure 1). The patient complained of itchiness in the same area, but no scratching marks were observed. There were no elevated bilirubin or biliary enzyme levels, ruling out pruritus caused by cholestasis.