Florid cutaneous and mucosal papillomatosis with acanthosis nigricans revealing a primary lung cancer

Abstract

This is the report of an 80-year-old patient with diffuse brownish hyperpigmentation and velvety thickening of the skin with onset 1 year before. Warty lesions on his limbs were present as well as papillomatous and verrucous lesions on his lips, mouth and eyelid conjunctivae with hyperkeratosis of the nipples. Biopsies, performed at different sites, showed histological pictures consistent with a diagnosis of acanthosis nigricans (AN) with florid cutaneous and mucosal papillomatosis. This type of AN is frequently associated with internal malignancy. In our patient serum levels of tissue polypeptide antigen, carcinoembryonic antigen, cytokeratin fragment and squamous cell carcinoma antigen were high and chest computed tomography scan indicated a large tumour infiltrating the right lung and extending to the mediastinum. Cytological examination of bronchial drainage revealed the presence of neoplastic cells, non-small cell type carcinoma. The most frequent cancer associated with malignant AN is gastric adenocarcinoma. Lung tumour has rarely been reported with AN. Malignant AN is sometimes associated with other cutaneous and mucosal warty lesions, as in our patient. These various skin and mucosal lesions are the expression of a systemic epithelial disorder and may help clinicians to suspect a malignant form of AN.

A Case of Generalized Acanthosis Nigricans with Positive Lupus Erythematosus-Related Autoantibodies and Antimicrosomal Antibody: Autoimmune Acanthosis Nigricans

“…No epidermal inclusion bodies were observed and polymerase chain reaction analysis of human papilloma virus DNA in the mucosal region was negative. These findings were compatible with a diagnosis of AN [1, 13, 14, 15]. …”

“…Malignancy-associated AN tends to be extensive and involves mucosal surfaces, mostly in elderly people. The majority of associated malignancies are intra-abdominal adenocarcinomas, most commonly gastric cancer [1, 13, 15]. In our case, the results of repeated examinations over a 10-year clinical course excluded malignancy-associated AN.…”

Clinical and pathologic findings of paraneoplastic dermatoses

“…15 The Leser-Trélat sign and florid cutaneous papillomatosis may also be present. 12,16 In 40% of the malignant acanthosis nigricans cases, pruritus and generalized skin hyperpigmentation can occur. In 25% of cases, palmar and plantar hyperkeratosis is present.…”

Florid cutaneous papillomatosis with acanthosis nigricans in a patient with carcinomas of the lung and prostate

“…Rarely it presents with other cutaneous and mucosal warty lesions (eg, CP). [1][2][3][4] In FCP, papillomas are most commonly located on the extremities, particularly on the backs of hands and wrists, but may disseminate to the entire body. 2 Furthermore, pachydermatoglyphy and intense J AM ACAD DERMATOL VOLUME 57, NUMBER 5 Letters 907 pruritus frequently accompany malignant AN.…”