Difficult BCC

On January 30, 2006, this 49 yo woman presented with a somewhat sclerotic plaque on the blub of the nose. By history, this has been present for 1.5 years. A 2 mm punch biopsy was taken at the site marked X.If this turns out to be BCC, I will refer for micrographic surgery. Does anyone feel radiotherapy is appropriate for a patient of this age?First Biopsy showed no evedence of BCC or malignancy. Repeat biopsy taken. Here is another clinical...

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Oral Hyperpigmentation

This 21 years student noticed hyperpigmentaiton of her buccal mucosae for one weeks.She has gingival hyperpigmentation for years and has a family history of the latter.Her health is good, and her only medication are albuterol and cromolyn sodium for asma.No history of cancer in any first degree relation.The examination show hyperpigmented buccal maculas measuring up to > 1 cm in diameter.Gingival hyperpigmentation is present as well.In the differential...

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9 year old child with inflammatory alopecia

The patient is a 9 year-old girl who was in her usual state of health until September 5, 2005 when her mother applied a "hair relaxer" to her scalp. Within a few days, she developed inflammation. The process has persisted and over the past few months she has developed fluctuant areas over the scalp with alopecia and some scarring. There is moderate discomfort.The examination shows a calm 9 year-old. Her scalp is involved globally with fluctuant...

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Rapidly Growing Tumor

This 70 yo man presented on January 9, 2006 with a three to four month history of a lesion on his upper back. It was noticed by his wife. He has type III skin and a past history of renal cell carcinoma.An excisional biopsy was performed.Presumptive diagnosis is melanoma, probably nodular type.Pigmented basal cell is another possibility, but rapid growth favors melanoma.I do not think metastatic renal cell carcinoma would be pigmented.January 25,...

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Suggestions for Wart Removal?

Dear Anak VGRD Members,I am a G.P. trainee and have been having a hard time with a wart removal on a 3 year old's fifth toe. The difficulty is getting him to let anyone near it. I've seen him once, late in the day, and my preceptor asked that the child return for freezing with the help of sedation. We are now working on what to use. I prefer to avoid having to sedate the child, and have suggested duct tape in the interim (six days on, one day off with soaking). What suggestions or tricks would you have for treating a wart in this...

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Explosive Rosacea?

The patient is a 33 year-old executive V.P. who presents with a 6 month history of dramatic facial eruption. He had acne as a teenager but has been clear for many years. His health is good and he takes no medication by mouth. He has never used topical corticosteroids for his face.The examination shows erythematous papules and small cysts on forehead, cheeks and chin. There are a few papules on the back, but the chest is clear.Diagnosis: Florid...

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