Acanthosis nigricans associated with malignancy (also known as "Acanthosis nigricans type I") is the "malignant" type of acanthosis nigricans that may either precede (18%), accompany (60%), or follow (22%) the onset of an internal cancer.[1]:506 Malignancy-associated acanthosis nigricans is usually rapid in onset and may be accompanied by skin tags, multiple seborrheic keratoses, or tripe palms.[2]:676