Suprabasal acantholysis--an unusual feature of necrolytic migratory erythema

A 67-year-old man with diabetes, weight loss and anaemia initially presented with a widespread scaling erythematous rash; a skin biopsy demonstrated marked suprabasal acantholysis. A subsequent biopsy showed localized upper epidermal necrolysis and the diagnosis of glucagonoma syndrome was later confirmed. Glucagonoma syndrome should be considered in patients with diabetes, weight loss and anaemia who present with a scaling rash, the histology of which shows suprabasal acantholysis. The extent of any upper epidermal necrolysis may be be very limited.