Dermclinic

This multi-factorial eruption requires topical or systemic antifungal treatment in conjunction with broad-spectrum antibacterial therapy, topical desiccating maneuvers (such as Burrow’s soaks), and discontinuation of OTC interventions that might be worsening the problem.

A large, asymptomatic nodule developed on the head of the penis of a 68-year-old man who was otherwise in good health.

The confluence of small, scaly, hyperpigmented patches on the chest (and often neck and upper back) is classic for tinea versicolor. What treatment would you recommend to prevent recurrence?

These firm, pigmented plaques, in a young African American, are most likely cutaneous sarcoidosis. This diagnosis was verified by biopsy.

The diagnosis of herpes (HSV-2) infection was confirmed by viral “culture.” While routine culture would not be expected to be successful when crusting has already developed, almost all laboratories actually now perform (more sensitive) PCR on specimens submitted for herpes “culture.”

This Iraqi woman was visiting relatives in the United States. Biopsy of the crusted erosion showed parasitized histiocytes, typical for leishmaniasis—an infectious parasitic disease endemic to the patient’s native country.

There is a rather large erythematous patch/plaque present. However, an exophytic, verrucous nodule is visible at the inferior border of the tumor. Biopsy of the flatter portion of this lesion disclosed squamous cell carcinoma in-situ, while biopsy of the nodule revealed invasive squamous cell carcinoma.

One of two common presentations of tinea pedis, this morphology is more common in those whose interdigital space is tight, leading to moisture retention and maceration. Diligent use of any topical antifungal will clear this.

This is a classic case of tinea pedis (athlete's foot). It was treated with a 2% preparation of an allylamine antifungal, a new addition to the menu of available topical agents.

This large bruise developed after the patient had an accident in her yard. Post-traumatic subcutaneous hematomas are common in elderly women, especially those who are anticoagulated. Untreated, the hematoma can eventuate into an abscess and even sepsis.

This lesion looks like basal cell or squamous cell carcinoma, but biopsy showed it to be an idiopathic inflammatory disorder of the external ear. Skin cancers of the pinna are rarely painful, as this lesion was.

This uncommon benign entity closely mimics squamous cell carcinoma, superficial basal cell carcinoma, and advanced actinic keratoses. The lichenoid keratosis does not transform into skin cancer.

The only impressive thing about this lesion was a "notch" in its superior pole, and some mild pigment heterogeneity. Prudent caution proved extremely beneficial. The history of a "new" lesion in a patient with almost no visible nevi, along with some very subtle gross features, led to early recognition and elimination of a malignant melanoma.

It is often surprising how wide and how deep skin cancers have already spread, despite a relatively small-looking superficial component. This patient had a history of melanoma in-situ.

Consider all relevant factors when deciding what steps to take with a pigmented lesion noticed by the patient or encountered during a routine physical examination.