2008-2009 Academic Year Archives - Dermatology Grand Rounds

Retroauricular ulcer in a patient with a history of multiple skin cancers

September 26, 2008

Presenter: Tony Nakhla, D.O.

Dermatology Program: Western University/Pacific Hospital of Long Beach

CHIEF COMPLAINT: “I have a skin cancer behind my ear”

CLINICAL HISTORY: A 55-year-old white male who presented to our clinic with a 2-week history of a painful sore on the right postauricular region. No history of prior treatment. The patient has a past medical history of multiple non-melanoma skin cancers including five squamous cell carcinoma and six basal cell carcinomas, three of which required Mohs. He reports no other significant past medical history and is on no medications. He smokes approximately one pack per day. The patient has no medical insurance and was concerned with procedural costs. He was willing to pay for a complete excision but did not want to pay for a biopsy since due to his history, he was convinced it was another skin cancer which needed to be removed.

Blisters on arms and legs

August 26, 2008

Presenter: Aaron Bruce, D.O., Roger Sica, D.O., Lyubov Avshalumova, D.O., Johnny Gurgen, D.O., Risa Ross, D.O., Rachel Epstein, D.O., Jessica Flowers, D.O., David Judy, D.O.

Dermatology Program: Nova Southeastern, Largo Medical Center, Sun Coast Hospital

CHIEF COMPLAINT: “Blisters on arms and legs”

CLINICAL HISTORY: We present a 50 y/o Caucasian female with a new onset of blisters on her thighs, arms, and axilla. Pt has a known history of Churg-Strauss Syndrome and states that she developed these blisters while on a prednisone taper. Pt denies any previous history of skin disease. She does state that these blisters become very irritated and painful at times. Pt denies oral lesions and constitutional symptoms. She denies starting, changing dosages, and frequency of any medications.

Multiple excoriations and erosions of the extremities

August 9, 2008

Presenter: Jason Mazzurco, DO; David Cleaver, DO; Brian Stewart, DO: Brooke Bair, DO; Billie Casse, DO

Dermatology Program: St. Joseph Mercy Hospital Ann Arbor/MSUCOM

CHIEF COMPLAINT: “Itchy sores on hands and feet”

CLINICAL HISTORY: An 81-year-old white male with a significant past medical history of chronic renal failure, bladder cancer and hemochromatosis presented with a three to four-week history of “sores all over his body.” He complained of pruritus, scratching and picking at the lesions. He also complained of chronically decreased urine output and swelling in both feet. He had previously been treated with diphenhydramine and hydroxyzine with little improvement of pruritus or skin lesions. The rest of the review of systems was unremarkable. He has been on hemodialysis for approximately 5 years for which he has a fistula in his left arm for dialysis access and has no history of diabetes mellitus. His medications at presentation included tramadol, diclofenac, alprazolam, metoprolol, losartan, omeprazole, diphenhydramine, and hydroxyzine.

Large yellow plaque on the tongue

July 26, 2008

Presenter: Shaheen Oshtory, D.O., Charles Gropper, M.D., Cindy Hoffman, D.O.

Dermatology Program: Saint Barnabas Hospital

CHIEF COMPLAINT: “My tongue hurts”

CLINICAL HISTORY: A 75 y/o female was admitted to St. Barnabas Hospital for metastatic malignant ascites secondary to vaginal cancer. On admission, she also complained of pain on her tongue and of a large, yellow plaque that had been present for several months. She denied any previous treatment. Her past medical history was significant for DM, HTN, chronic LBP, osteoporosis, bladder incontinence, and vaginal Cancer. Her current medications included Alendronate, Nexium, Neurontin, Lisinopril, Reglan, Etoprolol, MS Contin, Oxybutynin, and Zocor.

Sores on both hands

June 26, 2008

Presenter: Michelle Foley, DO, Brett Bender, DO, Joe Schneider, DO, John Coppola, DO, Brad Neuenschwander, DO, Derrick Adams, DO

Dermatology Program: Michigan State University POH Medical Center / Botsford Hospital

CHIEF COMPLAINT: “Painful sores on both hands”

CLINICAL HISTORY: A 41 yo Caucasian male presented to our clinic with the above chief complaint stating the lesions began to develop after he sustained an abrasion to his right third finger while at work. He began to note multiple similar lesions developing shortly thereafter and was admitted to a local hospital for presumed cellulitis. Unable to tolerate IV vancomycin, he was started on a short course of oral antibiotics and was referred to our service by the infectious disease physician for an evaluation to rule out presumed pyoderma gangrenosum. Hospital treatment consisted of IV vancomycin and a oral course of Bactrim without improvement. A two-week course of topical fluocinonide 0.1% cream and cephalexin 500mg TID was also unsuccessful. No pertinent past medical history. Social history included a 1-2 pk/day tobacco use, occasional ETOH with a history of remote abuse, no illicit drug use, and no recent travel. Family history was unremarkable. Review of systems significant for three years unintentional thirty-pound weight loss. Due to a lack of medical insurance, this had not been investigated previously.