Inclusion Criteria:  Patients with histologically confirmed diagnosis of locally advanced or metastatic lung adenocarcinoma with EGFR mutations, Patients with an Eastern Cooperative Oncology Group performance status score of 0-2, Patients receiving afatinib as first-line treatment to ensure a shorter time to observe skin adverse effects of any grade, Patients with measurable disease evaluated by the Response Evaluation Criteria in Solid Tumors (version 1.1), Patients with brain metastases were included after adequate treatment.  Exclusion Criteria: -