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Photo quiz

By Dr Nigel Stollery

By Dr Nigel Stollery

Case 1

This woman was concerned that an area of skin on the right side of her nose, shown in the picture, might be cancerous.

A biopsy was taken, after which the condition was diagnosed.

What is the condition called and what is the cause?

Case 2

In the case shown above, the patient had hundreds of neurofibromas affecting his whole body. These were removed as they had become large and uncomfortable.

What other signs are associated with this condition?

Case 3

This elderly man requested the excision of a darkly pigmented nodule overlying his patella.

The nodule had been present since he was seven years old, but as he had lost weight over the years it had become more prominent and the skin overlying it had become uncomfortable and tender at times.

What was the cause of the nodule?

Case 4

This 74-year-old man attended with a large nodule on his right hand. It had grown rapidly over the preceding few weeks, he had had a number of similar lesions removed in the past and was at risk of developing further lesions.

The patient's skin had worsened after an operation seven years earlier.

What procedure did the patient have during that admission?

Case 5

The large pyogenic granuloma shown in the picture developed after the patient cut his finger in the garden. The area often bled and was uncomfortable.

The lesion was removed by curettage and cautery and sent for histological examination.

What was the differential diagnosis?

Case 6

This patient originally presented with cold hands. She later developed other skin changes, including a widening of the cuticle and nailfold capillary dilatation.

Other nail changes associated with this condition include thinning and flattening of the nails and longitudinal overcurvature.

What is this condition called?

Answers

Case 1 Spectacle granuloma. It is caused by pressure resulting from glasses rubbing against the skin. No treatment is necessary, but a change of glasses might help

Case 2 Café au lait macules, axillary freckling and lisch nodules (iris hamartomas)

Case 3 A lead air gun pellet, which had entered his leg while he was shooting with friends. He had been too afraid to tell his parents so it had remained there for years

Case 4 Renal transplantation. Post-transplant antirejection therapy significantly increases the risk of viral warts and squamous cell carcinomas

Case 5 Squamous cell carcinoma or amelanotic melanoma

Case 6 Scleroderma

Author

Dr Nigel Stollery
MB BS DPD
GP, Kibworth, Leicestershire and clinical assistant in dermatology, Leicester Royal Infirmary

Case 4 Case 2 Case 3 Case 1 Case 5 Case 6

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