Clinical Quiz

Clinical Challenge: A Burning, Acneiform Facial Eruption

A white 24-year-old female presents with erythematous, papulopustular patches of skin in a muzzle-like distribution surrounding the mouth, chin, and glabellar region. Her history includes a variety of topical antibiotics that were previously successful with complete resolution; however, at present the lesions are persisting despite the treatment.

Clinical Challenge: Asymptomatic Lesion Above the Left Eye

A 36-year-old Hispanic woman requests removal of a lesion above her left eye that has gradually increased in size over the past 8 months. She denies itching or bleeding. She does not take oral medications and states that recent blood work was reported as “normal.” No similar lesions are noted elsewhere.

Clinical Challenge: Rash on the Abdomen and Upper Arms

A 75-year-old, obese woman is referred for evaluation of a rash affecting her abdomen and upper arms. The condition was first noted 6 months prior and is asymptomatic. Medical history includes adult-onset diabetes and hypertension. Prior treatments for the rash include ketoconazole shampoo and triamcinolone cream, both of which were ineffective.

Clinical Challenge: Itchy Lesion on the Chest

A 66-year-old man is referred for evaluation of a growth on his chest that he first noted several months ago. He denies history of skin cancer. The lesion has not bled but can be itchy at times. Examination reveals a 1.8cm, hyperpigmented plaque with a pinkish-red border. Multiple keratoses and lentigines are noted elsewhere.

Clinical Challenge: A Bleeding Mole on the Forehead

A 34-year-old woman presents requesting removal of a bleeding mole situated on her forehead. The lesion first arose approximately 3 weeks ago and rapidly grew. The patient denies history of a similar growth and provides a family history of basal cell carcinoma. The only medication she is currently taking is an oral contraceptive.

Clinical Challenge: Rash on the Lower Abdomen and Groin

A 56-year-old moderately obese woman is referred for evaluation of a rash affecting her lower abdomen and groin. The dermatitis has been present for approximately 1 year and occasionally burns and itches. Topical therapy with econazole was ineffective. Oral prednisone resulted in lightening but the condition flared as the dose was tapered. Examination revealed a well-demarcated, erythematous patch in the affected area. No abnormalities of the skin, hair, or nails were noted.

Clinical Challenge: Growth on the Left Index Finger

A 58-year-old man presents for evaluation of a mass affecting his left index finger. The lesion has been gradually increasing in size over the past 3 years and has recently become bothersome. He is currently taking medication to control hypertension and hyperlipidemia. He denies arthritis, gout, or history of trauma to the area.

Clinical Challenge: Flesh-Colored Growth on the Cheek

A 75-year-old man presents for evaluation of a growth on his right cheek. He believes that the lesion has been present for at least 2 years and is occasionally traumatized by shaving but is otherwise asymptomatic. Examination reveals a flesh-colored papule with a central umbilication.

Clinical Challenge: Dark Spots on the Arms

A 57-year-old woman presents with dark spots on her arms that she first noted several months ago. She denies itching and antecedent trauma. Medical history is positive for hypertension controlled with a thiazide diuretic. She has no history of skin cancer but admits to ample sun exposure. Examination reveals multiple nonblanchable, erythematous macules. The patient requested that a biopsy be performed.

Clinical Challenge: Asymptomatic Genital Rash

A 65-year-old man presents with an asymptomatic rash on his penis. He denies prior episodes of a similar rash, any recent sexual contact, or commencement of any new medications. Examination revealed well-demarcated erythematous patches of the corona and prepuce. No exudates or vesicles were apparent. He was treated with tacrolimus ointment 0.1% and econazole cream, resulting in resolution of the dermatitis at follow-up.