Acanthosis nigricans (AN) is characterized by hyperpigmentation and papillary hypertrophy, predominantly of major body folds. In extensive AN, it can be found on the areolae, around the umbilicus, and on the mucosa. Rarely, the involvement may be universal. 1 We herewith report such a case. Case Report A 62-year-old male agricultural worker came to us with asymptomatic gradually progressive generalized pigmentation of the body of 6 months duration. In addition, he had weight loss (>10 kg), anorexia, and profound weakness. For this complaint, he was examined in a hospital about 4 months back and was found to have a mass in upper abdomen. Ultrasound abdomen showed irregular wall thickening at antropyloric junction of stomach. Endoscopic examination showed an ulcerated growth at the same site. On exploratory laparotomy, an inoperable large growth was found at antropyloric junction of the stomach infiltrating pancreas. The abdomen was closed after a partial gastrectomy with anterior antecolic gastrojejunostomy Pathological examination of the infiltrating tumor mass revealed features of mucous secreting adenocarcinoma. Following surgery, his skin pigmentation continued to increase substantially.On general physical examination, there was moderate pallor. Cutaneous examination showed generalized, near universal, hyperpigmentation and velvety rugosities, more marked in periorificial sites, major body folds, around the areolae, dorsa of hands and feet. Numerous skin tags were also noted in the body folds. Bilateral palms and soles had velvety thickening. Finger tips demonstrated pachydermatoglyphy (exaggerated finger prints) (Fig. 1). Finger nails were thin and brittle (Fig. 2). Mucosal examination revealed scrotal tongue.
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