Insulin-resistant acanthosis nigricans, type A (IRAN, Type A) is a patch of velvety pigmented skin that arises in correlation with insulin-resistant diabetes mellitus. The clinical features include diabetes mellitus, acanthosis nigricans, and blackish, soft skin patches. Worldwide epidemiologic studies proposed that acanthosis nigricans is an effective marker for insulin resistance amongst obese subjects despite of the geographic location. Children of any ethnic group with a body mass index greater than the 98th percentile have a 62% prevalence of acanthosis nigricans, while the malignant acanthosis nigricans (benign form) has no tendency towards a specific ethnic group. IRAN, Type A affects both males and females equally. Lesions of benign acanthosis nigricans may occur at any age including at birth, though it is more common within adult population. Malignant acanthosis nigricans arises more frequently in elderly people; yet cases were described in children with Wilms tumor, gastric adenocarcinoma, and osteogenic sarcoma.