Tripe palm, i.e., velvety skin and Acanthosis nigricans- are these benign dermatological conditions or signs of malignancy?
A 73-year-old man presented with complaints of wart-like thickened skin of the palms and soles for the past 1 year. He also reported losing 8 kgs of weight in the past 6 months along with loss of appetite and generalized weakness. Does the patient have tripe palm as a sign of malignancy, or is it just a skin condition?
Examination:
On examination, the patient’s palms and soles had a rugose appearance with a ridged surface and exaggerated hyper linear dermatoglyphics. Additionally, head-to-toe examination revealed hyperpigmented and velvety papillomatosis of skinfolds on the groin and perianal regions.
The skin appearance resembled a diffuse cutaneous wart, therefore the physicians suspected diagnosis of warts. Hence, they took a sample from the affected skin of the left palm for biopsy.
Biopsy results revealed:
- Hyperkeratosis,
- Papillomatosis
- Marked Acanthosis of the epidermis
- No atypia of the cells or koilocytosis
Hence, with the examination finding and the biopsy results, the patient’s doctors diagnosed him with tripe palm and acanthosis nigricans.
Acanthosis nigricans (AN) is hyperpigmentation (brown to black) and velvety appearance of the skin folds. AN can be a sign of insulin resistance, and it can also occur as a paraneoplastic syndrome.
Tripe Palm:
Tripe palm, also known as acanthosis palmaris, and acquired pachydermatoglyphia, is a paraneoplastic syndrome seen in patients with gastric or lung carcinoma. The term ‘tripe’ is given due to the velvety appearance of the skin, which is similar to the stomach lining of a cow, pork, or sheep.
Identifying such palms is a rare finding, but when present, it is a strong indicator of malignancy. About 90% of the patients with tripe palm have underlying cancer. Therefore, in such patients, it is imperative to perform a full workup for primary malignancies. Hence, the doctors advised a computed tomography scan of the patient’s abdomen and upper gastrointestinal tract endoscopy (UGIT).
The tests revealed submucosal tumors of the gastric cardia.
The results of both, and the histopathological results, concluded a diagnosis of gastric adenocarcinoma.
The duo of tripe palm and acanthosis nigricans is most commonly seen in patients with underlying gastric carcinoma. Whereas, tripe palm alone is most commonly seen in patients with lung malignancy.
It is crucial, especially for the dermatologists, to be aware of this rare cutaneous condition since it is a paraneoplastic condition, often the first complaint of the patient with an undiagnosed underlying cancer.
References:
Abreu Velez AM, Howard MS. Diagnosis and treatment of cutaneous paraneoplastic disorders. Dermatol Ther. 2010 Nov-Dec;23(6):662-75.
Chakraborty PP, Datta S, Mandal SK, Kumar M. Tripe palm: a cutaneous manifestation of gastric carcinoma. BMJ Case Rep. 2014;2014:bcr2014206004. Published 2014 Oct 16. doi:10.1136/bcr-2014-206004
Wei-Ti Chen and Chia-Hui Chu; CMAJ April 01, 2019 191 (13) E366; DOI: https://doi.org/10.1503/cmaj.181104
