Cutis Rhomboidalis Nuchae

During a routine skin cancer screening, yellowed, thickened, leathery skin was noted on the posterior neck of a 73-year-old retired construction worker. Colloquially, this condition is called “sailor's skin” or “farmer's skin” and is seen in persons who have had long-term exposure to the sun. It is known clinically as cutis rhomboidalis nuchae, because the well-defined furrows in the skin resemble an irregular rhomboidal pattern.

Cutis rhomboidalis nuchae is one manifestation of actinic or solar elastosis, a degenerative change in the dermis caused by prolonged exposure to solar radiation. The disorder typically is seen in older persons, in those who live in sunny climates, and in outdoor workers. Persons with fair skin are more commonly and most severely affected, but it can occur even in those with darkly pigmented skin. The diffusely thickened and yellowish skin can arise in any area of the body that is chronically exposed to sunlight.

Because the neck has a propensity for hypertrophic scarring, such therapies as dermabrasion and laser abrasion usually are not considered. Topical application of a retinoid, such as tretinoin, or an a-hydroxy acid may partially reverse the degenerative changes. All forms of solar elastosis signal the need for a complete skin examination to exclude skin cancer.