Cutaneous clues: Malignant acanthosis nigricans and tripe palms as first signs of recurrent endometrial carcinoma

OBJECTIVE: 'Tripe palm' is a rare cutaneous paraneoplastic syndrome characterized by velvety thickening of the palms with a ridged or rugose appearance. The condition, either on its own or in combination with acanthosis nigricans, is strongly associated with internal malignancies, particularly gastric and lung cancers. Reports linking malignant acanthosis nigricans to endometrial cancer are scarce. Even more uncommon is its presentation as an initial sign of recurrent disease. CASE REPORT: We report a rare case of acanthosis nigricans and tripe palms in a 73-year-old woman who had completed treatment for stage IB endometrial endometrioid adenocarcinoma and remained disease-free for six years. She was referred by a dermatologist for evaluation of potential underlying malignancy. Chest CT, panendoscopy, and colonoscopy showed no significant findings. However, a PET/CT scan revealed a suspicious lymph node metastasis in the portocaval region. Laparoscopic excision of the retroperitoneal lymph nodes was performed, and pathological examination confirmed metastatic endometrioid adenocarcinoma with microscopic features consistent with the original endometrial carcinoma. CONCLUSION: Acanthosis nigricans and tripe palms are rarely linked to endometrial cancer, especially as indicators of recurrence. Gynecologic oncologists should recognize these cutaneous clues during patient surveillance, even if the patient has been disease-free for many years following treatment.