Acanthosis nigricans maligna (ANM) is a paraneoplastic phenomenon most commonly associated with visceral adenocarcinoma, in particular, gastric adenocarcinoma. Clinically, AMN is characterized by rapidly progressive symmetrical skin thickening and hyperpigmentation of the intertriginous areas with peripheral acrochorda. The diagnosis is made by a detailed medical work-up for occult malignancies with particular emphasis on endocrinological diseases. We report a 67-year-old man that presented clinically with acanthosis nigricans, in which a subsequent diagnosis of mycosis fungoides was made.

Background: Acanthosis nigricans (AN) is a dermatologic skin condition that is often overlooked in its role as an indicator of underlying cardiovascular disorders. Recognizing the importance of AN beyond its cosmetic concerns is crucial for improving patient outcomes. Objective: Provide a review of AN and what every dermatologist should know of its underlying cardiovascular risk. Methods: A literature search through PubMed was performed. Terms used were "Acanthosis Nigricans," "hyperinsulinemia," "cardiovascular disease," "diabetes," "insulin resistance,". Further articles were found using source materials from included references. Inclusion criteria involved studies showing the association between AN and cardiovascular risks, with a specific focus on obesity and insulin resistance. Results: Acanthosis nigricans increases risks of obesity and insulin resistance as individuals with AN exhibited a 2.6-fold higher likelihood of insulin resistance, independent of other factors. Acanthosis nigricans surpassed other risk factors in classifying individuals at risk for type two diabetes and cardiovascular disease. Conclusions: Recognizing the association of AN with cardiovascular disease provides an opportunity for early intervention, focusing on weight management and underlying metabolic disorders to improve both cosmetic concerns and cardiovascular health. Dermatologists should consider AN as a signal that prompts referral for a thorough assessment for associated metabolic diseases.

Lichen planus pigmentosus (LPP) is recognized as a rare variant of lichen planus, characterized by dermal hyperpigmentation. Specifically, a particular intertriginous variant of LPP is known as lichen planus pigmentosus inversus (LPPI). In our case, the patient presented with symmetric, hyperpigmented dark brown patches mainly in axillary areas, closely resembling the features of acanthosis nigricans (AN). The differential diagnosis considered included LPPI, AN, post-inflammatory hyperpigmentation related to contact dermatitis, symmetrical drug-related intertriginous and flexural exanthema, fixed drug eruption, and erythema dyschromicum perstans (EDP). Histopathological examination revealed the absence of hyperkeratosis and papillomatosis, typically associated with AN. Dermoscopy revealed diffuse brownish hue along with dots and globules of inconsistent size, which suggests dermal pigmentary incontinence and the likelihood of LPPI. This case illustrates the challenge in differentiating LPPI from similar flexural hyperpigmentation disorders based on the comprehensive approach including thorough history taking, clinical manifestations, histopathological analysis, and dermoscopic examination.

Extramammary Paget disease (EMPD) is a rare malignant neoplasm of apocrine sweat glands that is morphologically and histologically identical to Paget disease of the breast. The primary lesion is usually a solitary, well-demarcated, erythematous, scaly plaque that may contain crust, erosions, or ulcerations. The vulva is the most common site, but any area containing apocrine sweat glands may be involved. We present a case of triple extramammary Paget disease of the groin and bilateral axillae in a diabetic patient whose axillary lesions appeared consistent with acanthosis nigricans. This case demonstrates the need to consider EMPD in the evaluation of acanthosis of the axilla given its ability to mimic more common conditions.

Literature supports an association between work and cardiovascular disease in adults. The objective of this study was to examine the relationship between current work status and elevated blood pressure in Hispanic adolescents. Participants were students in Hidalgo County, located along the Texas-Mexico border. Participants enrolled in the cohort study in ninth grade with assessments completed once a year for up to three years. Participants completed a self-report survey, while staff measured height, weight, waist circumference, blood pressure, and were screened for acanthosis nigricans. A generalized linear regression model with a logit link function was constructed to assess current work status and elevated blood pressure. Of the 508 participants, 29% had elevated blood pressure, which was associated with being male and other chronic disease indicators (e.g., acanthosis nigricans, overweight/obesity). The mean probability for elevated blood pressure was higher among currently working adolescents compared to those who were not. Findings were statistically significant (p < 0.05) at baseline. The findings illustrate that a large proportion of adolescents along the Texas-Mexico border may have elevated blood pressure and that working may be associated with it. Subsequent research is needed to confirm these findings, as well as to identify the mechanism for how work may increase hypertension in adolescents.