A 67-year-old woman with a 6-year history of invasive breast carcinoma with bilateral axillary lymph node metastasis presented with a diffuse hyperpigmentation and pediculated brown papules with a velvety texture in the armpit flexures (Fig. 1) and enhanced ridges and velvety hyperkeratosis involving the palms (Fig. 2). The tongue and oral mucosa had similar findings. The cutaneous lesions had an abrupt onset by the time of the diagnosis. She underwent unilateral mastectomy, radiotherapy and chemotherapy. Currently, the disease is in remission with trastuzumab and hormone therapy and a total body scan found no lesions. The diagnosis of malignant acanthosis nigricans (MAN) and tripe palms (TP) was made.

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