Case Report
Malignant acanthosis nigricans, tripe palms and the sign of Leser-Tre'lat, a hint to the diagnosis of early stage ovarian cancer: A case report and review of the literature

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Abstract

Background

Malignant acanthosis nigricans is a mucocutaneous eruption associated with internal malignancies. Tripe palms refers to a characteristic velvety thickening of the palms, with exaggeration of normal skin markings. The sign of Leser-Tre'lat is the presence of multiple seborrheic keratoses and scattered skin tags caused by a malignancy. We are reporting the first case of ovarian cancer in association with three coexisting cutaneous paraneoplastic dermatosis.

Case

A 52-year-old female presented with skin manifestation consistent with MAN, TP and the sign of Leser-Tre'lat. Patient underwent extensive work up and was discovered to have stage I, high grade adenocarcinoma of the ovary. Skin manifestations gradually recovered after initiation of chemotherapy.

Conclusion

The presence of acanthosis nigricans in conjunction with tripe palms and the sign of Leser-Tre'lat are highly suggestive of an internal malignancy and necessitate an extensive investigation in order to discover the underlying malignancy.

Section snippets

Case report

A 52-year-old Caucasian female, who was previously healthy, was referred to the Cleveland clinic with the diagnosis of progressive acanthosis nigricans. In June 2004, she noted brownish discoloration of the skin on the neck, bilateral axillary region and groins followed by the appearance of velvety patchy lesions on the hyperpigmented area, then, a few weeks, later similar skin changes appeared under the breasts, a warty thickening of nipples was also noted, then she developed coarse thickening

Discussion

Our case represents the first occurrence of malignant acanthosis nigricans, tripe palms and the sign of Leser-Tre'lat in a patient with ovarian cancer.

Ovarian cancer is the 4th leading cause of female cancer-related death in the United States, most cases are asymptomatic at early stages and are not diagnosed until the tumor has progressed to advanced stages.

Malignant acanthosis nigricans (MAN) is a well-known paraneoplastic dermatosis. Although its exact incidence is unknown, in one study, it

Conclusion

MAN is a rare paraneoplastic dermatosis that can precede the diagnosis of the underlying cancer. The mechanism of development of malignant acanthosis nigricans has yet to be determined. The neoplasms associated with malignant acanthosis nigricans are typically aggressive in nature, mandating an extensive search for the underlying malignancy once the diagnosis of MAN is suspected, including clinical, laboratory and radiological investigations. Some authors even suggested consideration of

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