We record two cases of acquired hypertrichosis lanuginosa, bringing the total number of cases reported in the literature to nine. This sudden appearance of long, fine lanugo hair in an adult is a striking cutaneous sign of internal malignancy. From our study and review, this association with systemic cancer is even greater than a review of the literature would seem to indicate. Prominent red multiple papillae appearing the tip and distal third of the tongue appear to be an integral part of this syndrome. Two histologic features have not previously been reported. First, lanugo follicles extend almost parallel to the epidermal surface, deviating markedly from their normal near-vertical position. Second, many lanugo follicles are of the "mantle" type and contain lipidized cells within the mantle.