Triple palm, florid cutaneous papillomatosis and malignant acanthosis nigricans maligna as a first sign of gastric carcinoma

Authors report the case of a 68-year-old male with a history of well-controlled type 2 diabetes mellitus. Five months before his dermatological evaluation, he developed hyperpigmented facial lesions, alopecia, and multiple verrucous lesions on the oral mucosa, palms, and soles. These findings were consistent with acanthosis nigricans, pachydermatoglyphia, and florid cutaneous papillomatosis. The patient also had a 14 kg unintentional weight loss and altered bowel habits over the prior 10 months. Diagnostic workup revealed stage IV gastric adenocarcinoma. The combination of these three paraneoplastic dermatoses is exceedingly rare. Although some hyperpigmented dermatoses are known to be associated with malignancy, the association between pigmented lichen planus and cancer remains undocumented.