Images in Clinical Medicine

Acanthosis Nigricans

Maria Concetta Fargnoli, M.D., and Pasquale Frascione, M.D.

N Engl J Med 2005; 353:2797December 29, 2005

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A 37-year-old man was evaluated because of a two-year history of asymptomatic thickening and darkening of the skin on his axillae (Panel A), neck, face, and arms. The patient had no history of diabetes mellitus or other endocrine disorders, alcohol abuse, or chronic hepatitis. On examination of the skin, brown patches and plaques with elevated ridges and a velvety feel were observed on the axillary regions, the neck, the antecubital fossae, the dorsal aspect of the hands, and the malar and periorbital regions. Cutaneous findings were consistent with the diagnosis of acanthosis nigricans. An evaluation for cancer revealed a hepatic mass, 20 by 17 cm. The patient underwent right hepatic lobar resection. Histopathological examination of the resected tissue showed a moderately differentiated hepatocellular carcinoma with extensive hemorrhagic, necrotic, and sclerotic areas (T2N0M0). Three months after surgery, a spontaneous complete regression of cutaneous lesions occurred (Panel B). Malignant acanthosis nigricans is a rare form of acanthosis nigricans that precedes or occurs in association with often aggressive internal cancers and usually correlates with the evolution of the underlying neoplasm.

Maria Concetta Fargnoli, M.D.
Pasquale Frascione, M.D.
University of L'Aquila, 67100 L'Aquila, Italy

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