Severe, malignant acanthosis nigricans associated with adenocarcinoma of the endometrium

Acanthosis nigricans is a dermatopathy associated with insulin-resistance, drugs, endocrine disorders, chromosome abnormalities and neoplasia, known as malignant acanthosis nigricans. Malignant acanthosis nigricans is a rare paraneoplastic skin syndrome, most commonly associated with gastric adenocarcinoma and other intra-abdominal malignancies. There are very few reports in the literature of malignant acanthosis nigricans related to gynecological malignancies.
We report a case of a 28 year old, morbidly obese female with malignant acanthosis nigricans associated with endometrial adenocarcinoma. The patient presented with severe acanthosis nigricans involving the face, neck, axillae and forearms, confirmed on histopathology. Further investigations revealed she had grade 1 adenocarcinoma of the endometrium, which was subsequently treated with surgery.
Our case highlights the importance of performing skin biopsies to determine the histological diagnosis in patients with presumed benign lesions. Furthermore, clinicians should consider the possibility of underlying malignancy in patients with acanthosis nigricans and perform the appropriate screening, particularly in patients with sudden development of paraneoplastic dermatoses as this can be a clue to progression of malignancy.

Dr. Jacqueline Deen