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Acanthosis nigricans and bile duct malignancy

L Ravnborg1, K Thomsen

  • 1Department of Dermatology, Rigshospitalet, Copenhagen, Denmark.

Acta Dermato-Venereologica
|October 1, 1993
PubMed
Summary

This case study reports the first instance of acanthosis nigricans linked to metastatic adenocarcinoma. Early skin changes may precede cancer detection by years, necessitating repeated screenings for suspected malignant acanthosis nigricans.

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Area of Science:

  • Dermatology
  • Oncology
  • Pathology

Background:

  • Acanthosis nigricans (AN) is a skin condition characterized by hyperpigmentation and thickening, often associated with endocrine disorders or malignancy.
  • Malignant AN is a rare paraneoplastic sign, typically linked to adenocarcinomas, particularly of the gastrointestinal tract.

Observation:

  • This report details a unique case of acanthosis nigricans associated with metastatic adenocarcinoma of unknown primary, presumed to be cholangiocarcinoma.
  • The skin manifestations of acanthosis nigricans appeared two years prior to the clinical detection of the malignancy.
  • During this two-year period, the patient remained asymptomatic, highlighting a significant delay between dermatological signs and cancer diagnosis.

Findings:

  • This represents the first documented case of acanthosis nigricans associated with metastatic adenocarcinoma in the medical literature.
  • The study underscores the potential for acanthosis nigricans to be an early indicator of an occult malignancy, specifically adenocarcinoma.
  • The presumed primary tumor, cholangiocarcinoma, was identified only after a significant delay following the onset of skin changes.

Implications:

  • The findings suggest that acanthosis nigricans can serve as a crucial early warning sign for underlying adenocarcinoma.
  • In cases of suspected malignant acanthosis nigricans where initial screening fails to identify a primary tumor, repeated oncological surveillance is recommended due to the potential time lag.
  • This case highlights the importance of a multidisciplinary approach in diagnosing and managing patients presenting with paraneoplastic syndromes like acanthosis nigricans.

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