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How can you determine whether your patient with newly diagnosed diabetes has type I or type II disease?

Podcast: Does Your Patient Have Type I or Type II Diabetes?

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 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?

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?

A 5-year-old boy with a history of atopic dermatitis since 6 weeks of age, presents with a rash around his mouth that has been present for approximately 1 year. The patient’s mother reports that desonide topical cream was applied to the affected area for about 5 days, which initially resulted in improvement, however the rash returned after this medication was discontinued. The rash also recently improved after the patient took amoxicillin for an infection. She also notes that the patient has been licking his lips more frequently.

On examination there is an erythematous papulopustular eruption restricted to the perioral region, with sparing of the vermillion border. Mild hyperpigmentation is noted on the patient’s neck. There is no active involvement of other areas of the body.

The eruption has been present for 1 year and is restricted to the perioral region. What is included in your differential? 

Rash Around the Mouth of a 5-year-old Child

A 26-year-old man reports worsening fatigue and weakness for a few months. The history and physical examination were unremarkable. The patient’s father and grandfather had colon cancer when they were in their 40s. Colonoscopy revealed innumerable polyps carpeting the mucosa from the rectum to the cecum. Multiple polyps measured more than 1 cm and were on very large stalks.

A 26-year-old man reports worsening fatigue and weakness for a few months. The patient’s father and grandfather had colon cancer when they were in their 40s. Colonoscopy revealed innumerable polyps carpeting the mucosa from the rectum to the cecum. Your diagnosis?

Thousands of Colorectal Polyps: Your Dx?

This mobile tender nodule was discovered on the left wrist of a 60-year-old woman with a history of many non-melanoma skin cancers.

This mobile tender nodule was discovered on the left wrist of a 60-year-old woman with a history of many non-melanoma skin cancers. What’s your best diagnostic guess? 

Another Non-Melanoma Skin Cancer?

Irl B. Hirsch, MD

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