Clinical Pearl Wednesday #104

Caution Warning Danger Sign Symbol  - kreatikar / Pixabay

Have a patient presenting with Acanthosis Nigricans? Remember, Acanthosis Nigricans presents as a velvet hyperpigmented patch most common on the back of the neck or in the skin folds. It is typically caused by the skin’s hypersensitivity to hyperinsulinemia, which is why you see it in some diabetics.

What is critically important during the initial evaluation of this skin rash is the symptom onset. Has it suddenly developed (<3 months)? If so, then a gastric adenocarcinoma MUST be ruled out!

When this rash presents with a rapid onset, it could be one of the first signs of gastric adenocarcinoma. Remember this because treatment cannot be delayed as this type of cancer is typically very aggressive! Therefore, this patient will need urgent evaluation and referral.

2 Responses

  1. What do you suggest the referral procedure to be after noticing this in a client and they have NO idea when it started nor that is was even there? Also, Is it an alarm under 3 months in a Diabetic client?

    1. I would be alarmed in any patient if it appeared within 3 months.

      I would refer to GI immediately. If there is a long wait, then order an MRI or CT of the abdomen, but they really need endoscopy through GI.

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