DIAGNOSIS: Tripe Palms and Florid Mucosal Acanthosis
Tripe palm is a velvety rugose thickening of the palms strongly associated with internal malignancies, most commonly of the stomach and lung. There may be associated acanthosis nigricans, with oral acanthosis (or papillomatosis) also highly associated with internal cancers. Both skin findings may precede the detection of malignancy by many years.
So far, screening labs (cbc, comprehensive metabolic panel, and liver function tests), chest x ray, mammogram, and colonoscopy have been negative. However, with the high association of her skin findings with internal cancer further work-up is indicated.
Two other skin findings evident in this patient are also associated with malignancies. Multiple eruptive seborrheic keratoses, also known as the sign of Leser-Trelat, have been reported in association with stomach, breast, lung, and several other less common cancers. Hypertrichosis lanuginosa acquisita is an acquired excessive growth of vellus hairs over most of the face. This finding can be associated with drugs including steroids, cyclosporine, minoxidil, phenytoin, and by anorexia nervosa. However, with abrupt onset and no medication or anorexia history, the likely cause is paraneoplastic.
A tumor-produced humoral factor, TGF-alpha, may be responsible for epithelial
cell hyperplasia and the acute development of malignant acanthosis, tripe
palm, and eruptive seborrheic keratoses.
My thanks to Dr.Theresa Schroeder for her assistance in preparing this case.