Dermatologist Robert B. used VisualDx to create a differential for a female patient with hyperkeratotic nodules on her hands, forearms, and left leg and provide the proper treatment.
“A 79-year-old female presented with a sudden onset of multiple violaceous, hyperkeratotic nodules on the dorsal hands, forearms, and left lower leg over the course of 1-2 weeks. Pruritus dominated in symptomatology, although pain was also present. She was followed by oncology for clear cell renal carcinoma with metastases to the liver and lungs for which she was initiated on nivolumab four months prior after previously failing axitinib (a tyrosine kinase inhibitor). She did not have any history of previous skin disease. Biopsy from a characteristic lesion revealed a well-differentiated keratoacanthomatous squamous proliferation. Cultures for fungi, bacteria, and mycobacteria were all negative. Treatment with topical clobetasol ointment (daily) and intralesional triamcinolone acetonide suspension (20mg/mL, 0.1 mL per lesion) was pursued with subsequent improvement and resolution of the keratoacanthomas. She was able to continue nivolumab throughout the course of treatment.”
*Keratoacanthomas pictured here is not the patient in this case. See more pictures of keratoacanthomas in VisualDx.
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