Tripe palms and acanthosis Nigricans: A clue for diagnosis of advanced pancreatic adenocarcinoma

Tripe palms is an unusual cutaneous paraneoplastic syndrome characterized by a curious rugose thickening of the palms with an accentuation of the normal dermatoglyphic ridges and sulci. Tripe palms alone or in combination with acanthosis nigricans is strongly associated with internal malignancy, especially carcinomas of the gastrointestinal tract and lung. Any patient with tripe palms must have a complete cancer workup, as in many of the cases it often precedes the malignancy by many months. We report a rare case of tripe palms with acanthosis nigricans in a 50-year-old man with advanced pancreatic adenocarcinoma. Although relatively rare, an early diagnosis is very important to find out underlying malignancy and to improve the prognosis related to the neoplasia.