A 42-year-old male presents with a poorly defined, velvety hyperpigmentation of his axilla and groin. His past medical history is significant for obesity, diabetes and hyperlipidemia. Which epidermal layer will most likely show hyperplasia in this patient?
A. Stratum corneum
B. Stratum spinosum
C. Stratum granulosum
D. Stratum basale
E. Stratum lucidum
The correct answer is B.
Acanthosis nigricans is marked by brown to black, poorly defined, velvety hyperpigmentation of the skin, usually in the posterior and lateral folds of the neck, the axilla, groin, and umbilicus. It occurs due to insulin spillover (from excessive production due to obesity or insulin resistance) into the skin, which results in abnormal growth being observed. It is also associated with hyperlipidemia (Cushing’s disease and diabetes) and visceral malignancy. Histology shows hyperplasia of the stratum spinosum.
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