Malignant Acanthosis Nigricans
A 30-year-old woman presented to the dermatology clinic with a 3-month history of progressive skin lesions on her face. On physical examination, there were hyperpigmented, yellow, papillomatous papules and plaques on her lips, perioral area, and nasal creases (Panel A). Hyperpigmented velvety plaques were also seen on her neck, inguinal regions, and axillae (Panel B). She also reported new-onset heartburn, fatigue, and an unintentional 15-kg weight loss. Skin biopsy of a facial lesion showed epidermal papillomatosis, acanthosis, hyperkeratosis, and negative staining for human papillomavirus. A diagnosis of malignant acanthosis nigricans was suspected. Malignant acanthosis nigricans is a paraneoplastic dermopathy involving the sudden onset of velvety plaques on cutaneous and mucosal surfaces. The skin changes are more extensive and rapidly worsening than those in benign acanthosis nigricans. Computed tomography of the abdomen and pelvis showed thickening of the gastric body (Panel C, asterisks) and a solid mass measuring 4.4 cm in its largest diameter in the right ovary (Panel D, asterisk). A gastric biopsy showed mucin-rich signet-ring-cell adenocarcinoma, confirming a diagnosis of gastric adenocarcinoma with ovarian metastasis (also known as a Krukenberg tumor). The cancer initially responded to systemic therapy but had progressed by the 6-month follow-up. Huei-Jing Wang, M.D., Ph.D. Kaohsiung Medical University Hospital, Kaohsiung, Taiwan S. Chu-Sung Hu, M.B., B.S., M.Phil. Kaohsiung Medical University, Kaohsiung, Taiwan source: nejm.org