VEGFA and Abnormality of the skin: The diagnosis of POEMS syndrome was made based on the following findings: peripheral neuropathy (mild decrease of the median nerve conduction velocity), organomegaly (hepatosplenomegaly), endocrinopathy (gynecomastia), serum monoclonal protein elevation (IgA lambda 1295 mg/dL), skin changes (hyperpigmentation and hemangioma), plasma VEGF elevation (700 pg/mL; normal <117 pg/mL), and evidence of extravascular volume overload (edema, pleural effusion, and massive ascites).