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Images in Dermatology
June 26, 2019

Acanthosis Nigricans Maligna

Author Affiliations
  • 1Department of Dermatology and Venereology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
  • 2Department of Endocrinology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
JAMA Dermatol. 2019;155(9):1069. doi:10.1001/jamadermatol.2019.1127

A woman in her 60s presented with a 1-year history of progressively numerous seborrheic keratoses and velvety, gray-brown plaques on the face, neck, axillae, and perineum, causing bothersome ptosis and ectropion (Figure). She also reported a sensation of dry mouth and palms, but denied constitutional, gastrointestinal, genitourinary, and respiratory symptoms. Dermatologic examination confirmed the diagnosis of acanthosis nigricans (AN) and was also remarkable for palmar discoloration with accentuated dermatoglyphs, consistent with “tripe palms.” The patient had a known medical history of obesity, type 2 diabetes, hypertension and dyslipidemia, but her metabolic disorders alone could not explain such a florid clinical picture. As such, an occult neoplasm was suspected. A thorough laboratory, imaging, and endoscopic workup revealed an enlarged uterus with uterine masses. Further gynecologic examination revealed a 6-cm solid tumor of the cervix consistent with invasive endocervical adenocarcinoma which was confirmed by histopathologic analysis.

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