Acquired perforating dermatosis: an innocuous lesion with possibly ominous implications

Acquired perforating dermatosis encompasses several specific disease entities occurring in adults that often have overlapping clinical and histologic features. Although chronic renal failure and diabetes mellitus are the most common underlying conditions, several other more rare associations have been noted, including internal malignancy. We describe a case of acquired perforating dermatosis presenting as the first symptom in a 64-year-old man who also was diagnosed to have mild obstructive jaundice due to a periampullary villous adenoma with high-grade dysplasia. In a patient with no other risk factors, the presence of an acquired perforating skin lesion may warrant further investigation to rule out an underlying malignancy.