Case history
Case history
A 25-year-old black woman presents complaining of asymptomatic dark skin accompanied by skin tags on her posterior neck and axilla. She admits to recent 13.5-kg (30-pound) weight gain. There is a positive family history of diabetes mellitus. On physical examination, she is markedly obese. There are hyperpigmented, papillomatous, velvety plaques bilaterally in her axillae, extending onto her back and posterior and lateral neck. Numerous soft, pedunculated skin-coloured papules are present overlying and adjacent to the hyperpigmented areas. Blood tests show increased fasting blood glucose levels.
Other presentations
Malignant acanthosis nigricans (AN) has a sudden onset and rapid spread.[2][9][11] It is more likely than other types to affect mucosal surfaces and may present on the conjunctiva, oral mucosa, extending into the pharynx and larynx, and on anal and genital mucosa.[8][11][12][13] There is also more frequent acral involvement.[11] Palms and soles manifest yellow, papillomatous, hyperkeratotic plaques, which are also known as 'tripe palms'.[8]
Acral AN has hyperpigmented, papillomatous plaques on extensor surfaces with no involvement of flexures.[2] It usually occurs in healthy individuals. Benign AN tends to present at birth/early childhood and may be unilateral or generalised.[14] There is a positive family history, but usually no endocrine abnormalities or obesity.[2]
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