Acanthosis nigricans

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

• for endocrine disorders (diabetes, Cushing syndrome, acromegaly).

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Acanthosis nigricans

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