Know When to Cut, Know when to Punt

The patient is an 87 yo man with a mild dementia. He lives in an assisted care facility. Has an attentive and caring daughter. In October of 2007 he had a wide-local excision of s large SCC on the left forehead by a general surgeon. Path report showed "clear margins." When seen on May 30, 2008 a 4 x 3 cm recurrence was noted. The picture of the right TMJ area shows a scar from micrographic surgery from a similar lesion the patient had ~ 10...

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Two Foot and One Hand Disease

These are the hands of a 35 year-old plumber I saw recently. He was not aware of a dermatitis of his feet, but inspection showed mild moccasin-type T. pedis on both feet and subtle onychomycosis. KOH prep from the right hand was positive for septate hyaline hyphae. We all see two foot and one hand disease regularly. Do you have any theories as to why only one hand is involved? This is a peculiar dermatologic vignette.Right HandLeft H...

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Penile Pain

The patient is 40 yo heterosexual male in a monogamous relationship for the last 6 years. Neither he nor his partner has a history of having had sex with anyone else ever before.Three months ago he had the onset of pain at the tip of his glans during coitus and experienced pain also on pulling at the tip of his foreskin. A month later he noticed a few grouped "vesicles" at the ventral tip of his glans. These lesions have persisted unchanged. ...

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21 yo man with warty plaque on foot

Presented by Henry Foong, Ipoh, MalaysiaA 21 yr old student presented with 5-year history of warty growth on theright foot. It started as a small lesion which gradually got bigger.Pertinent findings on examination were raised hyperkeratotic plaque 5 x 3 cmon the medial border of the dorsum of the right foot. It has a verrucoussurface with blackish dots. Regional nodes were not palpable.Clinically he has chromoblastomycosis of the right foot.A biopsy...

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