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I’ll admit I was a little nervous to attend the annual American College of Physicians (ACP) meeting this year, what with the MOC snafu and the fall out. 

ACP 2015: "Still, Do No Harm" 

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?

Clinical Topics

What's This "Red Spot"?

A 27-year-old woman intermittently experiences painful oral lesions such as this one on her upper lip. She denies a history of genital lesions or ophthalmologic problems and is otherwise in superb health.

A 27-year-old woman intermittently experiences painful oral lesions such as this one on her upper lip. Your impression?

Oral Lesions

A 9-year-old boy presented with a 1-week history of pruritus and rash on his elbows, knees, back, and legs. Several areas of excoriation were noted. He had recently run through a field of tall grass but denied any other exposure history.

A 9-year-old boy presented with a 1-week history of pruritus and rash on his elbows, knees, back, and legs. He had recently run through a field of tall grass but denied any other exposure history. Your Dx?

What Cause of This Itchy Rash?


This intensely itchy, blistering rash on the forearms and upper chest of a 13-year-old girl occurred after a day at the beach. The girl had polymorphic light eruption (PMLE), the most common abnormal reaction to UV light.

A. PMLE classically presents as a papular or papulovesicular eruption on the arms and anterior chest

B. The reaction usually begins 12 to 24 hours after an initial exposure to light of a suddenly increased intensity

C. Some parts of the body are severely involved while similarly exposed areas are paradoxically spared

D. The rash resolves after 7 to 10 days, often leaving whitish scarring

What are the characteristics of this blistering rash caused by exposure to UV light? 

Intensely Pruritic Rash After Sun Exposure in a Tween Girl 

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 66-year-old woman had a mildly pruritic rash on the buttocks, lower back, abdomen, and upper posterior thighs. The eruption had been present for approximately 18 months.

A 66-year-old woman had a mildly pruritic rash on the buttocks, lower back, abdomen, and upper posterior thighs. The eruption had been present for approximately 18 months. Your diagnosis?

“Swimsuit Area” Rash: Your Dx?

Grace Farris, MD

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