In which of the following patients would you most likely find acanthosis nigricans?

Acanthosis nigricans is a skin condition characterized by dark, velvety patches of skin, often found in body folds such as the neck, armpits, and groin. Its association with insulin resistance is well documented, particularly in individuals who are obese or have metabolic syndrome.

In the case of the 55-year-old obese female with hyperinsulinemia, the presence of obesity and hyperinsulinemia suggests that she likely has insulin resistance, which is a common underlying cause of acanthosis nigricans. The skin changes occur due to the effects of elevated insulin levels on keratinocytes and dermal fibroblasts, stimulating skin proliferation and darkening.

Other options may present with different underlying health concerns, such as hematological issues or metabolic dysregulation, but they do not have a direct link to the classic etiology of acanthosis nigricans as seen in insulin-resistant states. Thus, the correct answer points to the scenario where the clinical picture most closely aligns with the typical causes of acanthosis nigricans.