Do you recognize this ominous sign?

What underlying condition is most likely?

A 62-year-old female presents with fatigue and innumerable pruritic, keratotic lesions on her back and neck which she says developed quite suddenly two months ago. A blood test reveals a microcytic anemia with hemoglobin of 9.1 g/dL. What is the most likely underlying condition?

A. Diabetes mellitus
B. Gastrointestinal malignancy
C. Hematologic malignancy
D. HIV

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