A 39-yearold woman presents with a thickened, hyperpigment velvety lesion over the axillae. This condition is associated with

skin tags may indicate insulin resistance. .Acanthosis nigricans manifests as areas of dark, velvety discoloration in body creases and folds such as the armpits, groin, and neck, sometimes causing skin to become thickened Ref Davidson 23rd edition pg 719