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Dermatology Hot Topics

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The lesion on this 6-year-old boy occupies almost the entire left side of his nose. The mother attributed it to an injury her son had sustained 2½ weeks earlier, when he was hit in the face by a baseball.

Is this lesion the result of an injury, as the boy’s mother suspected, or something else?

Clinical Topics

Scaly Plaque on the Nose

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

What's This "Red Spot"?

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma.

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma. The violaceous color and configuration of the skin lesions suggests which of the following? 

Hard Purple Nodules: Your Dx?

This full-term male infant is the product of an unremarkable pregnancy and a normal spontaneous vaginal delivery. His physical exam is otherwise normal. The right-sided groin swelling shown below is soft and compressible. It is unclear whether the testicle is contained within the affected hemiscrotum.

A compressible groin swelling is the only abnormal feature after full-term gestation and unremarkable delivery. Your Dx?

Hemiscrotal Bulge in an Otherwise Normal Neonate 

A 64-year-old woman with a history of basal cell carcinoma presents to the dermatologist for skin cancer surveillance. She is incidentally noted to have bruising on her upper eyelids (above). On questioning, she reports experiencing recurrent intermittent eyelid bruising for several years. She denies a history of trauma to her face, pain, or other associated symptoms.

Her medical history is significant for hyperlipidemia, hepatitis C (diagnosed >30 years earlier), osteoporosis, celiac disease, and idiopathic proteinuria for several years. Her surgical history includes appendectomy and carpal tunnel repair.

Pertinent family history includes her mother dying of multiple myeloma and her father of complications of diabetes.

Review of systems is significant for vague symptoms of gastrointestinal discomfort. On more directed questioning, she reports the eyelid purpura is temporally related to the Valsalva maneuver/ strained bowel movements. Her medications include atorvastatin, risedronate sodium, a daily multivitamin, calcium, vitamin D, and aspirin.

Her examination reveals no bruising elsewhere and no findings of interest on skin or mucous membranes.

B. Allergic contact dermatitis, purpuric type

Eyelid bruising was observed on a 64-year-old woman during routine skin cancer follow-up. She denied trauma or pain. What does this look like to you? 

Image IQ

Image IQ: Recurrent Eyelid Purpura 

A 64-year-old woman with a past medical history of hypertension, poorly controlled type 2 diabetes mellitus, hyperlipidemia, and obstructive coronary artery disease with prior stent placement was referred to the hospital by her primary care physician after laboratory testing revealed acutely elevated bilirubin. On evaluation, she reported 3 months of progressive fatigue and decreased exercise tolerance associated with generalized pruritus and jaundice. Vital signs were all within normal range.

Examination of the eyes was remarkable for bilateral scleral icterus. Skin examination revealed hyperpigmented, umbilicated papules with a central core (

) and larger plaques with central crusting (

 predominately in the shins, ankles, knees, forearms bilaterally, and back. Lesions were clean-based without surrounding erythema or purulent discharge. Labs were remarkable for a total bilirubin of 17 mg/dL with a direct bilirubin of 9.2 mg/dL, alkaline phosphatase of 1244 U/L, and slight AST elevation. Coagulation profile and balance of the comprehensive metabolic panel was within normal limits. She was admitted for work-up of unexplained hyperbilirubinemia and further evaluation of skin lesions.

 Hyperpigmented umbilicated papule with central keratotic plug

 Koebnerization resulting in large crusted plaque.  


Dermatology was consulted for evaluation of diffuse skin lesions. The differential diagnosis included the following.

Can you identify the cause of the hyperpigmented umbilicated lesions seen bilaterally on the patient's extremities and on her back?

Hyperbilirubinemia and Diffuse Skin Lesions in a Woman with Diabetes, CVD

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