[Systemic photochemotherapy (PUVA) in acanthosis nigricans maligna: regression of keratosis, hyperpigmentation and...

We report on a 60-year-old patient, who developed malignant acanthosis nigricans (MAN) with intense itching 2 years after a large-cell bronchial carcinoma had been diagnosed and found inoperable. The MAN became manifest at a phase of full clinical remission of the lung tumor, which had been treated with cytostasis (cisplatin, vindesine), high energy irradiation, and extirpation of the lymph node metastases. One year after onset of MAN, the lung tumor relapsed, accompanied by an elevated serum level of carcinoembryonic antigen (CEA). The patient was slightly obese, but not diabetic. The generalized MAN was treated with 18 exposures to systemic PUVA (photochemotherapy) over 9 weeks. The patient received 8-methoxypsoralene (8-MOP) orally and a total UVA dose of 52 J/cm2; the last exposure amounted to a maximum dose of 4 J/cm2. Under this treatment, the patient was completely relieved from tormenting pruritus; in addition, we observed significant regression of the pigmented keratoses as well as the intertriginous maceration.