Acanthosis Nigricans

The image displays a characteristic dermatological finding in the axilla. Which of the following conditions is most likely represented?

Acanthosis nigricans is most commonly associated with which malignancy in Indian populations?

Which pathophysiologic mechanism is primarily responsible for the skin manifestations in acanthosis nigricans?

A 52-year-old Indian man presents with progressive darkening and thickening of skin over his neck, axillae, and groin for the past 8 months. He reports associated weight loss of 6 kg over 3 months and mild pruritus. On examination, the affected areas show velvety, hyperpigmented plaques with exaggerated skin markings. His fasting blood glucose is 186 mg/dL, and HbA1c is 9.2%. Abdominal examination reveals a palpable epigastric mass. What is the most likely underlying diagnosis?

A 48-year-old Indian woman with a 10-year history of type 2 diabetes mellitus presents with progressive velvety darkening of her neck, axillae, and inframammary folds over the past 2 years. She denies weight loss and reports stable weight around 78 kg (BMI 32 kg/m²). Her HbA1c is 7.8%, and fasting insulin is 24 mIU/mL (normal: 2–12 mIU/mL). Skin biopsy shows acanthosis with papillomatosis and mild hyperkeratosis. Which of the following is the MOST appropriate next step in management?