16 yo girl with papulonecrotic lesions

The patient is a 16 yo girl with a 2 year history of papulonodular lesions on the extremities and face. There is no evidence that these are excoriations. Biopsy 9 months ago from the arm was read as prurigo nodularis, but lesions look atypical and have now started to appear on the face. She is well otherwise. A repeat biopsy on June 27. 2005 showed:DIAGNOSIS: Skin - Left Temple: Epidermal necrosis with s cale crust containing neutrophils , sub-epidermal...

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Bullous Eruption after Surgery

This 72 yo man had a laparoscopic cholecystectomy four months ago in Florida. Within a few weeks, he developed a bullous eruption around the area of surgery. His surgeon and primary care physician have treated with cephalosporins, topical mupirocin and triamcinalone cream. All without avail.A culture obtained at my office showed: coagulase negative staph resistant to everything except tetracyclines and rifampin. This is probably not significant.The...

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Rapidly Growing Lesion in a 57 yo woman

The patient is a 57 yo woman with a 6 month history of a papule on the right arm.The lesion measures 6 mm in diameter and had not diagnostic features. An excisional biopsy done since this was a rapidly growing lesion which was not clearly benign.Pathology shows a malignant melanoma, 2.3 mm thick, Level IV.Signed out as superficial spreading, but clinically looks more like a nodular melanoma.She has been referred to a dermatologic oncologist for wide...

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78 year old woman with unusual tumor

This 78 yo woman presented with a two week history of a dark growth on the posterior aspect of her shoulder. She had myalgias and felt unusually tired. The exam showed a tick engorged with blood. I could not tell if this was the deer tick that may carry Lyme Disease. Lyme antibidoes were ordered and she was started on amoxicillin 500 mg. tid for three weeks. She's a light complected Caucasian and doxycycline may cause photosensitivity in this...

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Cold Urticaria

1 month history Originally uploaded by David Elpern. MAY 31, 2005This 17-year-old high school student presented for evaluation of hives after exposure to cold air or products. This may have followed an upper respiratory infection. It has been present for only about a month. EXAMINATION: Dermographia is negative. After applying a cold soda can to her arm for two minutes, she developed an urticarial area exactly in the shape of the can...

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55 yo woman with new facial lesion

This 55 yo woman has has a one week history of a painful necrotic lesion on her left temple. She suffers from chronic pain and depression but is on no new meds. Her health is otherwise good. Her hemogram is unremarkable. Two days ago, she developed a similar lesion on her left shoulder. At present, it is just an erythematous papule with a surface erosion. He internist started her on cephalexin 500 mg bid before I saw her.Both lesions, by history,...

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