Derm Dx: Exaggerated skin markings on the posterior neck

Cutis rhomboidalis nuchae is a common sign of photoaging - a term that refers to cutaneous changes from chronic exposure to sunlight.1, 2Cutis rhomboidalis nuchae -- also called sailor's neck, farmer's neck, or leather neck -- refers to thickened and...

Submit your diagnosis to see full explanation.

Cutis rhomboidalis nuchae is a common sign of photoaging – a term that refers to cutaneous changes from chronic exposure to sunlight.^{1, 2}

Cutis rhomboidalis nuchae — also called sailor’s neck, farmer’s neck, or leather neck — refers to thickened and leathery skin on the posterior neck with exaggerated skin markings that form fissures or furrows in a crisscross pattern. There is often a yellowish hue to the skin.

Patients who develop cutis rhomboidalis nuchae typically have a fair complexion and have experienced significant exposure to sunlight. Patients frequently present with multiple other signs of photoaging and are at risk for developing skin cancers, particularly basal cell and squamous cell carcinomas. ^{1, 2}  Other signs of photoaging include the following.

Poikiloderma of Civatte, a disorder characterized by reddish to brownish patches with telangiectasias that appear on the lateral aspects of the neck. The lower anterior neck and “V” area of the superior chest may also be affected. Characteristically, the skin of the central neck immediately below the chin is spared. 

Colloid millium are translucent yellowish papules that occur on sun-exposed areas of the face, neck and back of the hands. Favre-Racouchot syndrome refers to large open comedones on the inferior orbital and malar skin.

Solar purpura is a condition characterized by easy bruising due to solar damage to the connective tissues of the skin. It is commonly seen as purplish bruising on the forearms and dorsal hands that subsequently fades to a brownish discoloration. 

Solar lentigines, also called liver spots, are irregular brown macules that occur on sun-exposed areas, especially the dorsal arms, forearms, V-area of the chest and face.  In contrast, stellate pseudoscars are white, scar-like plaques that present most commonly on the dorsal forearms. ^{1, 2}    

Diagnosis & Treatment

Cutis rhomboidalis nuchae is easily recognized as exaggerated skin markings on the posterior neck in a patient with a history of excessive sun exposure.  Biopsy is rarely necessary but will show significant solar elastosis. ^{1, 2}

There is no satisfactory treatment for cutis rhomboidalis nuchae. Screen patients for skin cancer and recommend photoprotection.

Adam Rees, MD, is a graduate of the University of California Los Angeles School of Medicine and a resident in the Department of Dermatology at Baylor College of Medicine in Houston.