Malignant Acanthosis Nigricans Associated with Ovarian Cancer

Abstract

Malignant acanthosis nigricans is a cutaneous eruption characterized by symmetric hyperpigmented hyperkeratosis, dermal papillomatosis, and mucosal involvement associated with internal malignancies. Tripe palms refers to a characteristic velvety thickening of the palms, with exaggeration of normal skin markings. We present the second case of ovarian cancer in association with two coexisting paraneoplastic dermatoses occurring in a 57-year-old Korean female. The presence of acanthosis nigricans in conjunction with tripe palms in a female patient is highly suggestive of an internal malignancy including an ovarian cancer and demands an extensive search for the hidden ovarian cancer.

Fig. 1

The patient presented with a diffuse velvety thickening and prominent ridges of the palms and soles.

Fig. 2

Well-defined thickened brownish plaques on the axillary area were observed.

Fig. 3

A skin biopsy of the hyperkeratotic plaque of the palm showed marked hyperkeratosis and acanthosis in the epidermis (HE, 100×).

Fig. 4

Histopathologic examination of the plaque in the axillae revealed hyperkeratosis, slightly irregular acanthosis and prominent dermal papillomatosis (HE, 100×).

Fig. 5

CT revealed a 13.6-cm sized cystic and solid mass in the uterus. There were multiple paraaortic and retroperitoneal lymph node enlargements.