Wart or Mimic? Part 2

Case 1:

Can you identify this asymptomatic lesion on the eyelid of a healthy 35-year-old woman?

Case 2:

A healthy 75-year-old man is concerned about this lesion on his face.

Is this a benign lesion, or something more ominous?

Case 3:

An otherwise healthy 23-year-old woman is bothered by these unsightly lesions that have been present on her abdomen since childhood.

Are they warts . . . or something else?

(Answers on next page.)

Case 1:

This is a periocular

filiform wart.

The brush-like keratotic tops of filiform warts distinguish them from skin tags and dermatosis papulosa nigra.

Case 2: This is a hypertrophic actinic keratosis, a squamous cell carcinoma confined to the epidermis. These lesions are white or pink and tend to appear in sun-exposed areas. They are keratotic rather than verrucous. Actinic keratoses favor the face and arms while warts favor the fingers, although either process can involve any part of the body.

Case 3: These are lymphangiomas, which are yellowish tan and composed of dilated, cystic lymphatic vessels; they resemble frog spawn. Unlike warts, these benign neoplasms are soft.

Case 4:

The shin of a 70-year-old woman who has peripheral artery disease but is ambulatory is shown here.

What does this look like to you?

Case 5:

The parents of a 12-year-old boy are worried about this lesion on his scalp, which has recently started to enlarge.

What can you tell them about the lesion?

Case 6:

What are the lesions seen here on the leg of a 57-year-old woman?

(Answers on next page.)

Case 4:

This patient has

lymphedema,

which commonly occurs in plaques on the shins, but can also appear as papules. It has a pebbly, rather than verrucous, surface.

Case 5: This is a nevus sebaceus, a congenital lesion most commonly found on the head and scalp. In children, the lesion is smooth, waxy, and hairless. During puberty, a massive development of sebaceous glands with epidermal hyperplasia occurs within the lesion. The surface becomes red or pink, verrucous, and papular.

Case 6: These are the nodules of perforating disease, a condition common in patients with end-stage renal disease; it is sometimes seen in patients with diabetes. Perforating disease typically has a keratotic core, whereas warts do not have cores.

Case 7:

A 40-year-old patient is distressed by these pruritic lesions.

Are these warts or something else?

Case 8:

What type of lesion is seen here on the face of a 55-year-old woman?

Case 9:

Can you identify these asymptomatic papules, which appeared several months ago in the groin of a 40-year-old man?

(Answers on next page.)

Case 7:

This is

prurigo nodularis,

a condition of unknown origin that resists treatment and may persist for years. The nodules, which are intensely pruritic, have a keratotic rather than a verrucous surfaceand are usually round.

Case 8: This is a seborrheic keratosis, a benign lesion with a "pasted-on" quality. The surface may be rough or smooth. Seborrheic keratoses do not manifest with the black dots that are the reification of thrombosed capillaries.

Case 9: This patient has condylomata acuminata (genital warts), hyperplastic lesions of the groin or genitals most commonly caused by human papillomavirus (HPV) types 6 and 11. They usually appear in clusters and may become pedunculated. Condylomata are softer than common warts, which are caused by HPV types 1, 2, and 4. HPV types 16 and 18 can cause condylomata acuminata that carry the risk of malignant degeneration and can also infect the cervix, with resulting cervical dysplasia and cancer.