History: This is a healthy 11 y.o. girl. Her mother noticed gradual darkening of skin in neck folds, axillae and groin around three years ago. The child is Chinese. Has not had her first menstrual cycle yet, although has some breast development. She is mildly overweight (not obese). Fitzpatrick Skin Type IV. No hirsuitism.
O/E: Velvety hyperpigmentation of skin folds. There are a few skin tags in axillae.
Clinical Photo:
Lab: Insulin Level 43 (normal 3 - 28) Hgb A1C (normal) , Serum Testosterone Level 75 (normal < style="font-weight: bold;">Histopathology: N/A
Diagnosis or DDx: Acanthosis Nigricans
Questions: How would you approach this patient and initiate an appropriate work-up?
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