Difficult BCC

From A.R. PitoNorfolk Island, S.P.A friend from Australia sent me this photo with the following note."A.R.: I just saw this 56 yo man with a two year history of a large ulcero-nodular plaque on his left temple. Biopsy is pending but this appears to be a morpheaform BCC. Assuming this is BCC, what would your therapeutic suggestions be.Radiotherapy?Mohs?In our area, we do not have a specialized cutaneous radiation centre, but he could be sent to...

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5 year old girl with perioral rash

This 5 year-old girl presents with a 5 month history of a dermatitis at angle of mouth and upper lip. There are areas of patchy erythema with scale and discrete acneiform papules. She has been treated with mupirocin cream, ketoconazole cream, and 1% HC cream. None of these have helped. She is not atopic, has no family history of atopy and is not a lip licker.Althoug subtle, I think this is perioral dermatitis of childhood. Tetracycline is contraindicated....

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A Patient from Ghana - Please comment

Anak VGRD members have been asked to comment on a 16 year old Ghanaian girl from a small village without any specialized medical care. In otherwise good health and of normal intelligence, since age two she has a history of small hyperpigmented papules on her face. The larger lesions on her forehead appeared over the last two years. She patient states that she doesn't manipulate any of the lesions and that they are asymptomatic. There has been...

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? Segmental Neurofibromatosis

The patient is a three year-old girl with 2 cafe au lait spots on right arm and chest since she was a few months old and many small "freckles" on right chest and axilla (see photo). There are a few freckles on the right upper back as well. No pigmented lesions on any other area. Have not looked for Lisch nodules yet.Athough it may be too early to tell, I suspect this is segmental neurofibromatosis. Most cases of segmental NF are diagnosed because...

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BCC of Eyelid

This is a 75 yo man who came in for an unrelated problem.This tumor was obvioius, however.Two years ago, and ENT physician told him he had a "blocked duct."This 6 mm in diameter lesion looks like a BCC.I propose to excise it but am worried about pulling down the lower lid.I don't think C&E or Aldara would be appropriate. Mohs might be overkill.Do you have any comments? I would, oif course, try to undermine the tiss...

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84 yo Man with Atrophie Blanche

The patient is an 84 yo man with a ten year history of extremely painful ulcerations of his lower legs.Other than whirlpool baths, I have found nothing to be of value.His health is good and he has bounding dorsalis pedis and posterial tibial pulses.I assume this is Atrophie Blanche. Do you have any therapeutic suggestoi...

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