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Adolescent boy with an expanding verrucous plaque
Adolescent boy with an expanding verrucous plaque Luke H. O’Steen, BS, Francesca J. Lewis, MD, and Benjamin S. Kuo, MD Charleston, South Carolina
An otherwise healthy 14-year-old male presented with a 3-year history of an expanding verrucous plaque on his left buttock. The physical examination revealed a 10- 3 8-cm verrucous, flesh colored to hyperpigmented plaque with a doughy, soft consistency. The lesion consisted of multiple nodules and tumors that had coalesced into a larger plaque (Fig 1). The remainder of the examination was unremarkable. A shave biopsy specimen of the lesion was obtained (Fig 2 and Fig 3). 1.
Based on the clinical history and histopathology, which of the following is the most likely diagnosis? A. Nevus lipomatosus cutaneous superficialis B. Piloleiomyoma C. Nevus mucinosis D. Lipofibroma E. Epidermal nevus
From the Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina. Funding sources: None. Conflicts of interest: None declared. Reprint requests: Francesca J. Lewis, MD, Department of Dermatology and Dermatologic Surgery, Medical University of
South Carolina, 135 Rutledge Ave, MSC 578, Charleston, SC 29425. E-mail: [email protected]. J Am Acad Dermatol 2012;67:e71-2. 0190-9622/$36.00 ª 2012 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2012.01.017
e71
e72 O’Steen, Lewis, and Kuo
2.
J AM ACAD DERMATOL
In children, this diagnosis has been associated with which of the following conditions? A. Tuberous sclerosis B. Proteus syndrome C. Bannayan-Riley-Ruvalcaba syndrome D. Generalized folded skin (‘‘Michelin Tire baby’’) E. Gardner syndrome
3.
Which of the following management strategies is most appropriate for this patient? A. Genetic testing for PTEN and excision B. Excision alone C. Screening colonoscopy and excision D. Ophthalmologic and renal evaluation and excision E. Thyroid function studies, screening mammogram, and excision Please visit http://www.eblueimages.org to answer these questions.
AUGUST 2012
An otherwise healthy 14-year-old male presented with a 3-year history of an expanding verrucous plaque on his left buttock. The physical examination revealed a 10- 3 8-cm verrucous, flesh colored to hyperpigmented plaque with a doughy, soft consistency. The lesion consisted of multiple nodules and tumors that had coalesced into a larger plaque (Fig 1). The remainder of the examination was unremarkable. A shave biopsy specimen of the lesion was obtained (Fig 2 and Fig 3). 1.
Based on the clinical history and histopathology, which of the following is the most likely diagnosis? A. Nevus lipomatosus cutaneous superficialis B. Piloleiomyoma C. Nevus mucinosis D. Lipofibroma E. Epidermal nevus
From the Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina. Funding sources: None. Conflicts of interest: None declared. Reprint requests: Francesca J. Lewis, MD, Department of Dermatology and Dermatologic Surgery, Medical University of
South Carolina, 135 Rutledge Ave, MSC 578, Charleston, SC 29425. E-mail: [email protected]. J Am Acad Dermatol 2012;67:e71-2. 0190-9622/$36.00 ª 2012 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2012.01.017
e71
e72 O’Steen, Lewis, and Kuo
2.
J AM ACAD DERMATOL
In children, this diagnosis has been associated with which of the following conditions? A. Tuberous sclerosis B. Proteus syndrome C. Bannayan-Riley-Ruvalcaba syndrome D. Generalized folded skin (‘‘Michelin Tire baby’’) E. Gardner syndrome
3.
Which of the following management strategies is most appropriate for this patient? A. Genetic testing for PTEN and excision B. Excision alone C. Screening colonoscopy and excision D. Ophthalmologic and renal evaluation and excision E. Thyroid function studies, screening mammogram, and excision Please visit http://www.eblueimages.org to answer these questions.
AUGUST 2012