Acanthosis Nigricans
Acanthosis Nigricans

Sequence 1 of 7.

Extensive Acanthosis Nigricans due to rectal carcinoma

A very extensive Acanthosis Nigricans, with
adenocarcinoma of the rectum.

A 73-year-old woman, that noticed a darkness of her face during a period of one year and a half. Rectal bleeding started 3 months previously. At the time of physical examination, we found this striking picture. Digital examination was performed, a hard mass was found at the rectum. A peptide growth factor from a tumor is related. Remission of the skin lesions occurs with removal of the tumor.

 

Acanthosis Nigricans.

Sequence 2 of 7.

Rectum Adenocarcinoma and Acanthosis Nigricans.

The patient was referred to us because of rectal blood discharge.

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Acanthosis Nigricans.

Sequence 3 of 7.

Suspicion for malignancy-associated acantosis nigricans should arise when it occurs when resent onset in a non-obese patient who does not have diabetes.

Acanthosis nigricans presents as a smooth, thickened, and dark appearance to the skin in body fold areas, most often in the axilla and around the neck If extensive, it may lead to a striking appearance, with thickening of the palms and soles and oral lesions of hyperkeratosis. Acrochordons (or skin tags) may also occur in affected sites. This clinical presentation is most often seen without malignant disease in obese patients, in certain insulin-resistant diabetes syndromes, as a familial trait, and with certain medications.

Acanthosis Nigricans.

Sequence 4 of 7.

There is no satisfactory dermatological or cosmetic treatment for acanthosis nigricans, and biopsy of the skin is neither helpful. The pigmented areas are reversible only when the tumor is removed.

Patients with gastric cancer occasionally present with paraneoplastic syndromes, such as acanthosis nigricans, membranous glomerulonephritis, microangiographic hemolytic anemia, arterial and venous thrombi (Trousseau syndrome), seborrheic dermatitis (Leser–Trélat sign), and dermatomyositis.

Attention should be focused on the possibility of gastric adenocarcinoma, although other intraabdominal and pelvic sites should also be evaluated for possible malignant disease.

 

Acanthosis Nigricans.

Sequence 5 of 7.

Suspicion for malignancy-associated acantosis nigricans should arise when it occurs when resent onset in a non-obese patient who does not have diabetes.

The malignant disease appears concomitantly in 61% of patients, but in almost 20% the acanthosis nigricans may precede the diagnosable tumor by years. In these patients, frequent surveillance is necessary. In a patient known to have had an abdominal adenocarcinoma who then develops acanthosis nigricans, a vigorous search for recurrence or metastatic disease should be undertaken. The mechanism of malignant acanthosis nigricans is thought to be related to peptide growth factors released by the tumor.

 

Acanthosis Nigricans.

Sequence 6 of 7.

Lateral view of her body.
Hyperpigmentation of some areas are seen.

 

Acanthosis Nigricans.

Sequence 7 of 7.

Extensive Acanthosis Nigricans due to rectal adenocarcinoma

A close up of her buttocks.

The hyperpigmented areas and queratosis of the skin are appreciated.

 

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