Acanthosis nigricans maligna (ANM) is a paraneoplastic phenomenon most commonly associated with visceral adenocarcinoma, in particular, gastric adenocarcinoma. Clinically, AMN is characterized by rapidly progressive symmetrical skin thickening and hyperpigmentation of the intertriginous areas with peripheral acrochorda. The diagnosis is made by a detailed medical work-up for occult malignancies with particular emphasis on endocrinological diseases. We report a 67-year-old man that presented clinically with acanthosis nigricans, in which a subsequent diagnosis of mycosis fungoides was made.
The Peng flap was originally described in 1987 as a viable option for re-creation of the convexity of the dorsum and nasal tip in a one step. Defects extending into the sidewall can result in multi-stage procedures. Beustes-Stefanelli in 2015 published a midline-based nasolabial transposition flap utilizing a single-stage repair for large defects of the nasal tip. There is minimal literature on large nasal tip defects repaired in a single stage and few modifications to the Peng flap. In this case, the sidewall involvement on top of the extent of nasal tissue removed limits the various different methods.
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