Sections

Workup

Laboratory Studies

In middle-aged and older patients with extensive skin or severe skin and mucosal findings, a workup for internal malignancy is indicated.

The vast majority of cases are due to obesity and/or insulin resistance. Screen for diabetes with a glycosylated hemoglobin level or glucose tolerance test.

Screen for insulin resistance; a good screening test for insulin resistance is a plasma insulin level, which will be high in those with insulin resistance. This is the most sensitive test to detect a metabolic abnormality of this kind because many younger patients do not yet have overt diabetes mellitus and an abnormal glycosylated hemoglobin level, but they do have a high plasma insulin level.

Procedures

Skin biopsy may be useful if clinical diagnosis is not easily made.

Histologic Findings

Histologic examination reveals hyperkeratosis, papillomatosis, with minimal or no acanthosis or hyperpigmentation. The dermal papillae project upward as fingerlike projections, with occasional thinning of the adjacent epidermis. Pseudohorn cysts may be present. Clinical dyschromia is secondary to the hyperkeratosis and not to increased melanocytes or increased melanin deposition. Dermal inflammatory infiltrate is minimal or nonexistent.

Mucosal acanthosis nigricans reveals epithelial hyperkeratosis and papillomatosis along with parakeratosis.^[1]

Note the image below.

Acanthosis nigricans biopsy. The epidermis is papillomatous (undulates) and pigmented ("nigricans"). Acanthosis (thickening of the spinous layer) is often not really present, so acanthosis nigricans is often a misnomer in many cases.

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Treatment & Management

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Media Gallery

Brown velvety plaques with skin tags in the axilla of a patient with acanthosis nigricans.
Acanthosis nigricans.
Acanthosis nigricans, obesity related.
Acanthosis nigricans of the axilla with one skin tag.
Acanthosis nigricans biopsy. The epidermis is papillomatous (undulates) and pigmented ("nigricans"). Acanthosis (thickening of the spinous layer) is often not really present, so acanthosis nigricans is often a misnomer in many cases.

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Table. Acanthosis Nigricans Associations

Table. Acanthosis Nigricans Associations

Syndromes Associated With Acanthosis Nigricans	Malignant Diseases Associated With Acanthosis Nigricans
Acromegaly	Bile duct cancer
Alstrom telangiectasia	Bladder cancer
Barter syndrome	Breast cancer
Beare-Stevenson syndrome	Colon cancer
Benign encephalopathy	Endometrial cancer
Bloom syndrome	Esophageal cancer
Capozucca syndrome	Gallbladder cancer
Chondrodystrophy with dwarfism	Hodgkin disease
Costello syndrome	Kidney cancer
Crouzon syndrome^[10]	Liver cancer
Dermatomyositis	Lung cancer
Familial pineal body hypertrophy	Mycosis fungoides^[11]
Gigantism	Non-Hodgkin lymphoma
Hashimoto thyroiditis	Ovarian cancer
Hirschowitz syndrome	Pancreatic cancer
Lawrence-Moon-Bardet syndrome	Pheochromocytoma
Lawrence-Seip syndrome	Prostate cancer
Lipoatrophic diabetes mellitus	Rectal cancer
Lupoid hepatitis	Testicular cancer
Lupus erythematosus	Thyroid cancer
Phenylketonuria	Wilms tumor
Pituitary hypogonadism
Pseudoacromegaly
Prader-Willi syndrome
Pyramidal tract degeneration
Rud syndrome
Scleroderma
Stein-Leventhal syndrome
Type A syndrome (HAIR-AN syndrome)
Werner syndrome
Wilson syndrome

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Author

Jason H Miller, MD Clinical Assistant Professor of Dermatology, Rutgers Robert Wood Johnson Medical School; Private Practice, Hametz and Picascia Dermatology Associates

Jason H Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Frank Winsett, MD University of Texas Health Science Center at Houston

Disclosure: Nothing to disclose.

Ronald P Rapini, MD Professor and Chair, Department of Dermatology, The University of Texas MD Anderson Cancer Center; Distinguished Chernosky Professor and Chair of Dermatology, Professor of Pathology, University of Texas McGovern Medical School at Houston

Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, American Society of Dermatopathology, Association of Professors of Dermatology, Society for Investigative Dermatology, Texas Dermatological Society

Disclosure: Book royalties from Elsevier publishers.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Ponciano D Cruz, Jr, MD Professor and Vice-Chair, Paul R Bergstresser Chair, Department of Dermatology, University of Texas Southwestern Medical Center

Ponciano D Cruz, Jr, MD is a member of the following medical societies: Texas Medical Association

Disclosure: Received consulting fee from RCTS for independent contractor; Received honoraria from Mary Kay Cosmetics for consulting; Received grant/research funds from Galderma for principal investigator.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Jonathan Baron, MD, and Norman Levine, MD, to the development and writing of this article.

Acanthosis Nigricans Workup

Laboratory Studies

Procedures

Histologic Findings

References

Tables

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