title: "Neglected nipples": acanthosis nigricans-like plaques caused by avoidance of nipple cleansing.
abstract: BACKGROUND
  Acanthosis nigricans (AN) develops sporadically or in association with obesity, insulin-resistance and dark pigmentary phenotype. Unusual clinical presentations of AN may be diagnostically vexing.
  
  
  OBJECTIVE
  The aim of the report is to present unusual clinical and dermoscopic pictures of hyper-keratotic, brownish lesions of the nipples resembling acanthosis nigricans.
  
  
  METHODS
  Data including clinical and dermoscopic features of two patients with the "neglected nipples": acanthosis nigricans-like (AN-like) hyperpigmented plaques caused by avoidance of nipple cleansing.
  
  
  RESULTS
  Beside the anamnestic clue, presentation of AN-like plaques in the "neglected nipples" is limited to the breasts, in the absence of involvement of other flexural sites classically affected by AN. Dermoscopy aids the exclusion of a tumor, as it reveals exclusively structureless, brown-gray-black hyperkeratosis in the absence of criteria associated with melanocytic or non-melanocytic skin neoplasms of the nipple. The "neglected breasts" are easily treated by keratolytic creams and hygiene.
  
  
  CONCLUSIONS
  The "neglected nipples" condition, presenting as bilateral AN-like papules and plaques of the nipples, is due to avoidance of cleansing of the nipple area, resulting in accumulation of keratotic cellular debris.
authors.affiliation: Center for Cancer Prevention and Treatment, Katowice, Poland.
authors.forename: Grazyna
authors.initials: G
authors.lastname: Kaminska-Winciorek
authors.affiliation: Center for Cancer Prevention and Treatment, Katowice, Poland ; Department of Conventional and Intraoperative Radiotherapy Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Wydmanski
authors.affiliation: Dermatology Department, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Scope
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova- IRCCS, Reggio Emilia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Argenziano
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova- IRCCS, Reggio Emilia, Italy ; Department of Dermatology, Medical University of Graz; Graz, Austria.
authors.forename: Iris
authors.initials: I
authors.lastname: Zalaudek
keywords: acanthosis nigricans-like; dermatoscopy; dermoscopy; hyperkeratosis; neglected nipples; nipple hygiene