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This is a very distinct, rare, and remarkable hemorrhagic rash, first recognized in 2006, with 7 known cases reported in the literature. 

Enoxaparin Dermatosis

This image of the posterior neck of a 26-year-old woman shows a warty type fungating  lesion about the size of a quarter. It had been present since birth. It had been excised and treated with electrodessication several times previously but had always recurred. She had acute and chronic anxiety and would pick at the lesion.

The lesion was elliptically excised under local anesthesia in the office.

This lesion on the posterior neck of a young woman was present since birth and recurred after electrodessication. Can you Dx? 

Clinical Topics

A Warty, Fungating Lesion 

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

What's This "Red Spot"?

The mother of a 10-year-old boy brings him in for evaluation of his moles (which are all benign). During the visit, the mother asks about the lesions on the first 2 knuckles of his right hand; she initially noticed them several months earlier. The boy is otherwise healthy.

White Knuckles

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma.

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma. The violaceous color and configuration of the skin lesions suggests which of the following? 

Hard Purple Nodules: Your Dx?

This asymptomatic, hyperpigmented, hairy lesion is on the left upper back of a 16-year-old boy. The pigmentation was first noted 5 years earlier; the coarse and dark hair confined to the hyperpigmented area had appeared at age 13 years. History and physical examination findings were unremarkable.

This asymptomatic, hyperpigmented lesion was first noted 5 years earlier on the left upper back of a 16-year-old boy. A nevus? Cafe au lait spot? 

Hairy Brownish Patch

For 2 months, a 29-year-old man had pain and circular, soft swelling (7 x 7 cm in diameter) over the anterior left knee, superficial to the patellar ligament. Pain was minimal and associated with extension and flexion.

Medial collateral and lateral collateral ligament injury

For 2 months, a 29-year-old man had pain and circular, soft swelling (7 x 7 cm in diameter) over the anterior left knee, superficial to the patellar ligament. Your dx?

Swelling Over Left Anterior Knee

BS

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