Acanthosis nigricans

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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167 Acanthosis nigricans

Instruction

Perform a general examination.

Salient features

History

• Age (>40 years of age more likely to be associated with malignancy; in younger individuals more likely to be associated with endocrinopathies)

• Carcinoma stomach or other neoplasms (in 80% the cancer is abdominal and in 60% the cancer is in the stomach): symptoms of weight loss, asthenia and decreased appetite

• Diabetes mellitus (insulin-resistant diabetes)

• Endocrinopathies: acromegaly, Cushing’s disease, polycystic ovaries, hypothyroidism, hyperthyroidism.

Examination

• Black, velvety overgrowth seen in the axillae (Fig. 167.1), neck, umbilicus, nipples, groins or facial skin

• Acrochordons or skin tags may accompany acanthosis nigricans and occur in similar areas.

image

Fig. 167.1 Acanthosis nigricans in the axilla.

Proceed as follows:

• Look for the following signs:

• Tripe palms (roughness of the palmar and plantar skin; Fig. 167.2)
• Filiform growths around the face and mouth, and over the tongue (when mouth and tongue are involved it is highly suggestive of an underlying neoplasm) (Fig. 167.3).

• Tell the examiner that you would like to investigate for:

• underlying malignancy, in particular adenocarcinoma of the stomach
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