Image of the Week: Discolored Plaques on the Neck and Axillae

A 48-year-old man presents to his family physician concerned about the discoloration on his neck. He first noticed it 1 month earlier and has been trying to clean the area without success. He is otherwise healthy, although he notes that his clothes fit more loosely than they did last year. Examination reveals hyperpigmented, velvety plaques on the neck and axillae. His body mass index is 22 and his glycated hemoglobin (HbA1_c) is 5.1%. Given the rapid appearance of this hyperpigmentation with no evidence of insulin resistance, an occult malignancy is considered.

Which of the following malignancies is most commonly associated with this presentation?

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