Melanoma

A 32-year-old woman, who recently gave birth, seeks evaluation of 2 lesions onher neck. A linear, medium brown, warty, 4-cm lesion has been present sinceshe was born; there has been no disproportionate growth or change in color.The crusted 0.5-cm nodule at the most cephalad aspect of the linear lesiondeveloped in early pregnancy and has gradually enlarged.

An area of pigment loss in the skinand surrounding hair is noted on thehead of a 10-year-old boy. Examinationof the vertex of the scalp revealsa nevus encircled by depigmentation.

A 32-year-old man recently noticed a dark lesion behind his right knee. The patientdenies trauma and fever and has no other medical problems. Since he started workingfor the parks and recreation department of the state of Florida 18 months ago, hehas spent an increased amount of time outdoors.

For several weeks, a 68-year-old man has had painful blisterson his hands that crusted as they healed. The patienthas diabetes mellitus, hypertension, and chronic renalfailure, for which he is undergoing hemodialysis. His longtermmedications include a hypoglycemic agent and adiuretic.

For several months, a 26-year-old man has had persistent bumps on his scalpand the back of his neck. Some hair loss has also occurred at the site.

The parents of a 3-year-old girl seekmedical evaluation of the nodules ontheir daughter’s back. The lesionshave been present since birth andhave grown with the child.

During a routine checkup, a middle-aged woman asks you whether she should stop wearing moisturizers and makeup that contain sunscreen. She has read that increased sunlight exposure enhances vitamin D production, which may prevent certain types of cancer. What would you tell her?

We read with great interest the “Dermclinic” case of a 44-year-old man with achanging pigmented lesion on his trunk (CONSULTANT, March 2001, page 354).

An 83-year-old man with a history of hypertension and coronary artery disease presented with a 4-day history of mental status changes, slurred speech, and difficulty ambulating. He reported a lack of appetite and weakness of several days.

These benign tumors made up of nevus cells may be flat or raised, pigmented (Figure A) or nonpigmented.

A minute, nonpigmented, innocuous-appearing papule on the nose of a 60-year-old man did not seem cause for alarm. However, a simple, 3-mm punch biopsy saved this patient's life.

This asymptomatic pigmented lesion on the left posterior jaw of a 52-year-old man had been present for 6 years, with no evidence of recent change. At the patient's request, the lesion was excised.

An 82-year-old man with Alzheimer's disease and atrial fibrillation was referred for evaluation of a lesion present for an undetermined period. It was initially noted 1 week earlier, at his first office visit with a geriatrician.

Seen here is an ulcerated tumor with irregular borders on the left foot of a 37-year-old man. He said the tumor had developed several years ago.

A 45-year-old woman who had had several melanomas removed was concerned because of hyperpigmentation beneath her toenail. Some distal onycholysis was also noted. Because of the patient's history and the fact that she could not definitely recall injuring the toe, a partial nail evulsion was performed. Fortunately, the only finding was dried blood.

Recurring blisters on the sides of the fingers brought a 72-year-old man to his physician. He was asked to change into a gown for a full-skin examination. Physical examination demonstrated minute papulovesicles affecting the medial and lateral aspects of the fingers, consistent with dyshidrosis. The patient's skin was severely sun-damaged, and there was an irregularly pigmented, asymmetric patch affecting the posterolateral neck.

Referral for biopsy was made because a 6-mm, red and black, dome-shaped papule on a 43-year-old woman's left groin resembled a melanoma. The patient had numerous cherry hemangiomas on her trunk-bright red, 2- to 5-mm papules that are among the most common vascular anomalies.

This red papule developed 6 months ago at the base of a 53-year-old woman's thumb. The lesion was asymptomatic, but it bled easily when traumatized. It was treated definitively with surgical excision, and the biopsy report was consistent with the clinical diagnosis of pyogenic granuloma. This most commonly appears on the face or fingers and may result from minor trauma.

A previously asymptomatic, largeblack plaque on a 65-year-old man’sscalp recently began to bleed. The lesionhad grown considerably since itfirst appeared as

For the past several weeks, a 54-year-old man has had progressivelyworsening abdominal pain and general achiness.He has no nausea, vomiting, diarrhea, or fever and no historyof trauma.

An 83-year-old man witha history of hypertensionand coronary arterydisease presented with a4-day history of mentalstatus changes, slurred speech, anddifficulty ambulating. He reported alack of appetite and weakness of severaldays.

Painful erosions developed on the sole of a 14-year-old girl's foot several weeksearlier. Within the last few days, the condition has spread to the other sole.The patient is otherwise healthy and takes no medications. She enjoys playingsoccer and has no history of trauma.

Four pink nodules appeared in a linear array on the proximal extensor right forearm of a 77-year-old man. The asymptomatic lesions, which ranged from 0.5 to 1.0 cm in diameter, had been present for 2 months.

A middle-aged woman had had alow-grade fever, sore throat, and malaisefor 1 week. Her physician prescribedamoxicillin. Three days afterstarting the medication, an asymptomaticerythematous and petechialeruption developed over the patient’sentire body.