Abstract
The authors present a case of malignant acanthosis nigricans that has two unusual aspects. The first is involvement of the lid margins with confluent papillomata, causing severe visual impairment, and the second is the association with lung malignancy. A 65-year-old Portuguese man presented with decreased vision, papillomatous lid lesions, pruritus, and progressive thickening of the skin of his face, neck, axillae, and inguinal creases. A diagnosis of acanthosis nigricans was made after skin biopsy. Systemic investigations showed a suprahilar mass, and biopsy was positive for squamous cell carcinoma of the lung. The patient underwent excision of papillomata from all four lid margins, and this was repeated 1 year later. He also completed a course of palliative radiotherapy. Malignant acanthosis nigricans is rarely associated with lung neoplasms, being more commonly a manifestation of intra-abdominal malignancies. Of note in this case is the extensive ocular involvement and visual impairment.
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