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January 2004
By Stephen M. Schleicher, MD, and Lawrence
A. Schiffman, DO
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CASE:
You are asked to see an 87-year-old woman to evaluate lesions
on her face. A wheelchair-bound nursing home resident, she
has Alzheimer's disease and many other medical problems but
no history of skin cancer. Examination reveals numerous hyperpigmented,
waxy, exophytic papules and plaques scattered over the lateral
face and neck and ranging in color from light tan to dark
black. According to her nurses, none of these lesions has
changed in size and color over the past several months.
WHAT IS YOUR DIAGNOSIS?
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Seborrheic keratoses are the most common lesions encountered
in the dermatology office, so common that they have been called
"the barnacles of life." Almost everyone will eventually develop
at least one of these, typically in the fifth or sixth decade.
Lesions that have changed or are atypical in presentation should
be biopsied. Occasionally, growths that have been clinically
diagnosed as seborrheic keratoses prove to be malignant melanoma
when examined microscopically. The sudden appearance of multiple
keratoses in association with an underlying carcinoma is termed
the sign of Leser-Trelat. |
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Dr. Schleicher is director of the DermDx
Centers for Dermatology of Northeastern Pennsylvania and Schleicher
Dermatology Associates in Bonita Springs, Florida, and a clinical
instructor of dermatology at Philadelphia College of Osteopathic
Medicine, Kings College in Wilkes-Barre, Pennsylvania, and
Arcadia University in Glenside, Pennsylvania. He is also a
member of the EMERGENCY MEDICINE editorial board. Dr. Schiffman
is a fellow at the DermDx Centers for Dermatology.
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