Malignant acanthosis nigricans, florid cutaneous and mucosal papillomatosis, and tripe palms in a man with gastric adenocarcinoma.

We describe the case of a 67-year-old man with a clinical history of smoking, hypertension, and hyperhomocysteinemia. The patient was referred for verrucous lesions on the face that had appeared more than 1 month earlier. A dermatological examination revealed several small, hyperkeratotic lesions on the cheeks and around the mouth (Figure 1A), as well as brownish plaques in the axillary and inguinal folds (Figure 1B). Both hands showed marked accentuation of the dermatoglyphics (Figure 1C). The patient reported that these symptoms had appeared abruptly within a period of less than 2 months. Based on clinical suspicion of a paraneoplastic dermatosis, additional tests were requested to identify the primary tumor. Analyses revealed a cholestatic pattern with elevated levels of alkaline phosphatase and -glutamyl transpeptidase. Tumor marker analysis revealed only a slight increase of -fetoprotein levels. A thoracoabdominopelvic computed tomography scan revealed a lytic lesion in the posterior third of the T12 vertebral body, with slight invasion of the medullary canal, minimal thickening of the antral wall (Figure 2A), and swelling of the periaortic lymph nodes and gastrohepatic ligament lymph nodes (Figure 2B). An upper endoscopy revealed a malignant-looking ulcerated lesion with irregular borders in the area of the gastric incisura, extending towards the gastric body. Biopsy of the