Acanthosis Nigricans – A Two-Sided Coin: Consider Metabolic Syndrome and Malignancies!


  • Uwe Wollina Academic Teaching Hospital DresdenDepartment of Dermatology and Allergology
  • Gesina Hansel Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital
  • Torello Lotti University of Rome “G. Marconi”, Rome, Italy
  • Georgi Tchernev Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
  • Aleksandra Vojvodic Military Medical Academy of Belgrade, Serbia, and University of Rome Guglielmo Marconi Rome, Italy
  • Ivanka Temelkova Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria



Acanthosis nigricans, Metabolic syndrome, Malignancies, Paraneoplasia


BACKGROUND: Acanthosis nigricans (AN) is acquired hyperpigmentation of the intertriginous body regions. Histologically, AN is characterised by a thickened stratum corneum and a variable amount of acanthosis. Although benign and rarely symptomatic, AN may be a red flag for underlying pathologies.

CASE PRESENTATION: We analysed our patients with AN and could differentiate three different patterns, that are illustrated by one case report each. The is the benign AN associated with metabolic syndrome including obesity. The second type is the paraneoplastic AN malignancy which is associated with a wider range of malignancies. This type may occur before, after or with the clinical appearance of the malignancy. The third type is relapsing AN after complete remission. We present a patient who had a malignant AN and was treated successfully for his cancer. Years later, however, AN relapsed. In that case in association with the appearance of skin tags. Cancer restaging excluded a tumour relapse. His BMI was 31.2 kg/m2, and the diagnosis of benign AN was confirmed.

CONCLUSIONS: The diagnosis of AN remains incomplete without screening for metabolic syndrome and/ or cancer. The combination of AN and skin tags is more often associated with metabolic syndrome. AN may be considered as a red flag for malignancies and the metabolic syndrome.


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Author Biographies

Uwe Wollina, Academic Teaching Hospital DresdenDepartment of Dermatology and Allergology

Head of Department of Dermatology and Allergology

Gesina Hansel, Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital

Senior Advisor

Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital

Torello Lotti, University of Rome “G. Marconi”, Rome, Italy

Professor of Dermatology

Department of Dermatology, University of Rome “G. Marconiâ€, Rome, Italy


Aleksandra Vojvodic, Military Medical Academy of Belgrade, Serbia, and University of Rome Guglielmo Marconi Rome, Italy

Professor of Dermatology

Military Medical Academy of Belgrade, Serbia, and University of Rome Guglielmo Marconi Rome, Italy


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How to Cite

Wollina U, Hansel G, Lotti T, Tchernev G, Vojvodic A, Temelkova I. Acanthosis Nigricans – A Two-Sided Coin: Consider Metabolic Syndrome and Malignancies!. Open Access Maced J Med Sci [Internet]. 2019 May 13 [cited 2023 Sep. 27];7(18):3081-4. Available from:

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