The Dermatology Grand Rounds was originally founded by Dr. Bill Way and Dr. Rick Lin under the leadership of AOCD President Cindy Hoffman DO FAOCD in 2002. Over the past 2 decades, the Residency Programs of the American Osteopathic College of Dermatology have been submitting interesting cases for publication. We welcome your comments and submissions.
Large, Indurated, and Painful Plaque on the Forehead
Presenter: Francisca Valenzuela, MD, Thomas L Davis, MD, Michael Hohnadel, DO
Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program
Program Director: Rick Lin, DO MPH FAOCD
Submitted on: June 12, 2024
CHIEF COMPLAINT: Large red protruding lesion on forehead
CLINICAL HISTORY:
Signs and symptoms: A 60-year-old female with no past medical history presented to the clinic with a large red lesion on her forehead and frontal scalp. The patient stated that it began as a small nodule approximately six months prior to her visit and had grown quickly, causing discomfort. She reported no history of head and neck surgeries or procedures. Notably, she had been seeing an oncologist for a couple of months due to anemia of unknown origin, and the oncology team referred her to dermatology for further evaluation of the large plaque.
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Patient with chronic painful nodule on left third fingernail
Presenter: Francisca Valenzuela, MD, Thomas L Davis, MD, Michael Hohnadel, DO
Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program
Program Director: Rick Lin, DO MPH FAOCD
Submitted on: March 22, 2023
CHIEF COMPLAINT: painful nodule on finger nail
CLINICAL HISTORY:
Signs and symptoms: A 79-year-old female with no significant past medical history presented to the clinic with a painful nodule on her left third fingernail that had been present for 10 years. The patient reported that the nodule had been slowly growing and became very painful when she submerged her hand in cold water. For the past two years, she had been treated by a midlevel provider who diagnosed her with onychomycosis and a bacterial infection of the left third fingernail. Despite multiple courses of doxycycline and ciclopirox, she noted no improvement in her condition.
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Patient with multiple grouped vesicles surrounding border of a previous surgical scar
Presenter: Francisca Valenzuela, MD, Thomas L Davis, MD, Michael Hohnadel, DO
Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program
Program Director: Rick Lin, DO MPH FAOCD
Submitted on: June 14, 2023
CHIEF COMPLAINT: “I have persistent growths on my back around a prior surgical scar”
CLINICAL HISTORY:
Signs and symptoms: A 23-year-old male with no significant past medical history presented to our clinic with multiple grouped lesions on his back surrounding a previous scar. The patient and his parents reported that he has had these spots since childhood, though they could not confirm whether he was born with them. They also did not remember the specific surgical procedure that created the scar during his childhood. The patient was worried about the spots, as they had recently begun to bleed. He denied any personal or family history of skin cancer.
Seemingly Innocuous Skin Findings: A Surprising Turn in Clinical Evaluation
Presenter: Eric Sandrock, DO, Thomas L Davis, MD, Rick Lin, DO
Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program
Program Director: Rick Lin, DO MPH FAOCD
Submitted on: September 18, 2024
CHIEF COMPLAINT: “A new pimple grew on my arm “
CLINICAL HISTORY:
Signs and symptoms: A 67-year-old male with a medical history of hypertension, coronary artery disease, non-melanoma skin cancers, lower esophageal adenocarcinoma, and intracranial arteriovenous malformations, presented to our clinic to discuss biopsy results from a lesion on his left cheek. The biopsy confirmed the presence of a nodular and pigmented basal cell carcinoma. During this visit, the patient also reported a new papule on his left proximal forearm, which he indicated had been present for only a few weeks. He denied any bleeding or discomfort associated with the new lesion.
The patient’s surgical history includes a coronary artery bypass graft (CABG) procedure involving four vessels, as well as previous excisions for skin cancers: a basal cell carcinoma on the right shoulder that underwent Mohs micrographic surgery and a squamous cell carcinoma on the left forearm that also received Mohs treatment. His current medication regimen includes Nexium and Hydrocortisone, and he denied any allergies to medications. The patient reports no pertinent family history. He denies smoking, illicit drug use, or alcohol consumption.
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Progressive Vascular Anomalies and Musculoskeletal Symptoms in an Adult Patient
Presenter: Valeria González-Molina, MD, Thomas L Davis, MD, Rick Lin, DO
Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program
Program Director: Rick Lin, DO MPH FAOCD
Submitted on: September 18, 2024
CHIEF COMPLAINT: “I have many dark growths and bruises all over my arm ”
CLINICAL HISTORY:
Signs and symptoms: A 50-year-old male presented to our clinic with pain in his right hand and forearm that had been intermittently treated as cellulitis with oral antibiotics. The patient reported that he was born with a hemangioma on the right forearm, which has been growing in size and number over time. He denied trauma to the area and joint pain, but endorsed a limited range of motion affecting his daily activities. He also reports easy bruising. He denied any systemic symptoms, including fever, chills, shortness of breath, weight loss, and fatigue. He denied any history of recent travel or sick contacts. No other household members had similar lesions. His only pertinent surgical history was an excision of two subcutaneous lesions of the right antecubital fossa 20 years ago. The only medications the patient reported taking was gabapentin 300 mg BID.
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