The correct answer is D. Ovarian cancer.

Dermatomyositis (DM) is an autoimmune polymyositis with characteristic cutaneous findings. In the photo you can see a classic heliotrope sign – which is a classic sign of DM. Patients with DM should be screened for an underlying malignancy. Risk factors for having an underlying malignancy include a negative ANA, adult age, and female gender. Ovarian cancer is one of the most frequently associated with dermatomyositis.

Brain, thyroid, rectal, and liver cancer are not commonly associated with DM.

Cancers associated with DM include: Colon, breast, lung, gastric, nasopharyngeal carcinoma (southeast asia), pancreatic, lymphomas.

Risk of cancer in DM patients returns to normal about 2-5 years after onset.

References: In Bolognia, J., In Schaffer, J. V., & In Cerroni, L. (2018). Dermatology.