630 by a surgeon, 151 by a plastic surgeon, 190 by a dermatologist, and 26 by specialists in other disciplines. General and plastic surgeons performed partial biopsies only in a small percentage of the cases (1983, 3%; 1986,2%; 1988,1 %) whereas dermatologists performed many. Far fewer incisional and punch biopsies were performed by dermatologists in 1988 than in 1983 and 1986 (1983, 45%; 1986,...

1 of 2 DESCRIPTION A 30-year-old male presented with headache and acral enlargement ( fi gure 1 ).On examination, he had bitemporal hemianopia, acanthosis nigricans, skin tags and cutis verticis gyrata (CVG) from which he was asymptomatic ( fi gure 2 ). On investigation, serum growth hormone (GH) after 75 g glucose load was 26.8 ng/ml (N, <1 ng/ml) with insulinlike growth factor 1 (IGF-1) of 11...