Acral acanthosis nigricans may be a marker of internal malignancy

A 34-year-old male patient, a known case of ileal carcinoid tumor with secondaries in the liver (since 2013) presented with asymptomatic, symmetrical, velvety, and black patches over the dorsum of metacarpophalangeal, metatarsophalangeal, and interphalangeal joints of hands and feet [Figure 1], with sparing of axillary folds, other intertriginous areas and palms for the past 1 year or so. Histopathological examination of skin biopsy from dorsum of hand revealed epidermal hyperkeratosis and papillomatosis, findings consistent with acanthosis nigricans. Based on the history, examination, and typical histopathological findings, a diagnosis of acral malignant acanthosis nigricans was made. Acral acanthosis nigricans is thought to be more common in dark complexion races with no association with systemic diseases. It has been reported with dermatofibrosarcoma protuberans, non-Hodgkin’s lymphoma, and gastric adenocarcinoma.^[1] In the present case, acral-type acanthosis nigricans was accompanied by the presence of rare ileal carcinoid tumor.

Close

Figure 1:

Bilateral symmetric velvety black patches over the dorsum of metacarpophalangeal, metatarsophalangeal, and interphalangeal joints of hands and feet.

Export to PPT