A woman in her 60s presented with a 1-year history of progressively numerous seborrheic keratoses and velvety, gray-brown plaques on the face, neck, axillae, and perineum, causing bothersome ptosis and ectropion (Figure). She also reported a sensation of dry mouth and palms, but denied constitutional, gastrointestinal, genitourinary, and respiratory symptoms. Dermatologic examination confirmed the diagnosis of acanthosis nigricans (AN) and was also remarkable for palmar discoloration with accentuated dermatoglyphs, consistent with "tripe palms." The patient had a known medical history of obesity, type 2 diabetes, hypertension and dyslipidemia, but her metabolic disorders alone could not explain such a florid clinical picture. As such, an occult neoplasm was suspected. A thorough laboratory, imaging, and endoscopic workup revealed an enlarged uterus with uterine masses. Further gynecologic examination revealed a 6-cm solid tumor of the cervix consistent with invasive endocervical adenocarcinoma which was confirmed by histopathologic analysis.Acanthosis nigricans is clinically characterized by symmetric, hyperpigmented, velvety or verrucous plaques in intertriginous areas. It is a cutaneous manifestation of internal disease, most often associated with benign conditions (80%), such as obesity, insulin resistance, and diabetes. Less frequently it represents a paraneoplastic dermatosis, called acanthosis nigricans maligna (ANM), which is in most cases associated with abdominal malignant tumors, especially adenocarcinomas, like gastric cancer. 1 This form of AN typically has a rapid onset and extensive skin involvement, and generally affects adults older than 40 years. It can be accompanied by other cutaneous paraneoplastic manifestations, including tripe palms, so called owing to the resemblance of velvety palmar skin to the stomach lining of ruminants, and the "sign of Leser-Trélat", corresponding to the abrupt appearance of multiple seborrheic keratoses. 1,2 Acanthosis nigricans maligna can present concurrently or following tumor detection, but may also precede the diagnosis and serve as an important clinical clue. 1 Its presence should therefore prompt a thorough workup for malignant abnormality, comprising physical examination and comprehensive complementary investigation, including endoscopic and/or imaging methods.Because ANM skin findings usually improve with treatment of the underlying tumor and worsen with disease recurrence or progression, dermatologic examination is crucial for follow-up. 3 This case is a reminder of how the recognition of particular skin findings can lead to the diagnosis of internal malignant tumors. 3 It also represents a rare clinical observation because, to our knowledge, only a few cases of ANM in association with gynecologic tumors-including ovarian, endometrial, and cervical cancershave been reported. [2][3][4]