A 77-year-old man had fleshy papillomatous lesions on his eyelid margi
ns, which initially were accompanied by lesions on his lips and tongue
and plaques on his scrotum, areolae, neck, axillae, and hands. He had
had adenocarcinoma of the sigmoid colon and stomach. Based on the cli
nical findings and histopathologic evaluation of the eyelids (showing
papillomatous changes with hyperkeratosis and mild acanthosis), the di
agnosis of acanthosis nigricans was made. Acanthosis nigricans may be
benign or malignant; in this patient it was malignant. The malignant f
orm is usually of gastrointestinal origin, and in adults may be a mark
er for an occult malignancy.