Background: Acanthosis nigricans (AN) is a dermatologic skin condition that is often overlooked in its role as an indicator of underlying cardiovascular disorders. Recognizing the importance of AN beyond its cosmetic concerns is crucial for improving patient outcomes. Objective: Provide a review of AN and what every dermatologist should know of its underlying cardiovascular risk. Methods: A literature search through PubMed was performed. Terms used were "Acanthosis Nigricans," "hyperinsulinemia," "cardiovascular disease," "diabetes," "insulin resistance,". Further articles were found using source materials from included references. Inclusion criteria involved studies showing the association between AN and cardiovascular risks, with a specific focus on obesity and insulin resistance. Results: Acanthosis nigricans increases risks of obesity and insulin resistance as individuals with AN exhibited a 2.6-fold higher likelihood of insulin resistance, independent of other factors. Acanthosis nigricans surpassed other risk factors in classifying individuals at risk for type two diabetes and cardiovascular disease. Conclusions: Recognizing the association of AN with cardiovascular disease provides an opportunity for early intervention, focusing on weight management and underlying metabolic disorders to improve both cosmetic concerns and cardiovascular health. Dermatologists should consider AN as a signal that prompts referral for a thorough assessment for associated metabolic diseases.