Vinod Warrier,1 Ali Ahmad,1 Yaqoub Alshatti,1 Ali Jafar,2 1Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait; 2Department of Surgical and Interventional Sciences, University College London, Royal Free Hospital, London, UK Background: Digital necrosis is a rare phenomenon of paraneoplastic syndrome associated with squamous cell carcinoma of the tonsil. Since 1965, more than 70 cases have been reported worldwide in the literature.Case report: A 54-year-old male smoker presented with Raynaud’s phenomenon, proceeding to frank gangrene of the fingers. Working up the case finally pointed toward carcinoma of the tonsil as the underlying cause – a rare paraneoplastic manifestation.Conclusion: No definite etiology has been found to be the cause of Raynaud’s phenomenon in this case of the squamous cell carcinoma of the tonsil. A brief discussion of the literature is also presented. Keywords: acronecrosis, digital necrosis, paraneoplastic manifestations, Raynaud’s phenomenon, squamous cell carcinoma of the tonsil