A 60-year-old man comes to the physician with a growth in his left ear. It has been present for a while and never bothered him, but his wife insisted that it be "checked out." His past medical history is significant for hypertension treated with amlodipine and losartan. He has no family history of cancer. He had a colonoscopy 2 years ago and 2 small adenomatous polyps were excised. The skin examination findings are shown in the photograph below.

Which of the following is the most likely diagnosis?

Question

A 60-year-old man comes to the physician with a growth in his left ear. It has been present for a while and never bothered him, but his wife insisted that it be "checked out." His past medical history is significant for hypertension treated with amlodipine and losartan. He has no family history of cancer. He had a colonoscopy 2 years ago and 2 small adenomatous polyps were excised. The skin examination findings are shown in the photograph below.

Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec193a_977c_8428_853d_4d808548a09d_MD0002_00 The patient has a seborrheic keratosis (SK). SKs are benign epidermal tumors commonly found in older adults. They are less common in dark-skinned populations. The number of SKs can range from a single lesion to hundreds in the same individual. The Leser-Trélat sign, which is the explosive onset of multiple itchy seborrheic keratoses, has been associated with a number of malignancies, particularly gastrointestinal cancers. SKs are most commonly asymptomatic but can be pruritic or tender, particularly in locations that come into contact with clothing or jewelry. Diagnosis is based on their clinical appearance. Typically, these lesions have "stuck-on," verrucous, pigmented (skin-colored to black), and sharply demarcated appearance. They are frequently found on the face, upper extremities, and trunk. Lesions do not occur on the palms and soles. No therapy is required unless the lesions become irritated or the patient desires them removed for cosmetic reasons. Treatment options include removal by snip/shave excision, cryosurgery, and electrodessication. (Choice A) Actinic keratosis is a premalignant lesion characterized by dry, scaly, flat papules with an erythematous base. This condition predisposes a patient to squamous cell carcinoma. Actinic keratosis (Choice B) The most common presentation of basal cell carcinoma is a slow-growing papule or nodule with a pearly, rolled border and overlying telangiectasia. Ulceration is commonly observed, as is bleeding following minor trauma. basal cell carcinoma (Choice C) Lentigo maligna is a slowly evolving type of melanoma in situ that typically occurs in sun-damaged skin of the face and neck of older individuals. It presents as an atypical macular lesion characterized by irregular shape, variegated color, and variable size. Lentigo maligna (Choice D) Cutaneous neurofibromas commonly present as soft, flesh-colored, or hyperpigmented papules or nodules < 2 cm in diameter. They are benign skin lesions that occur sporadically and are typically solitary in healthy adults. Applying direct pressure to some neurofibromas may cause them to retract into the skin, a finding known as the "button-hole" sign. Multiple neurofibromas should prompt consideration of neurofibromatosis. Multiple neurofibromas Educational objective: Seborrheic keratoses (SKs) are very common benign growths with a warty or cerebriform, "stuck-on" appearance. The explosive onset of numerous SKs has been associated with a variety of malignancies, particularly gastrointestinal cancers. No therapy is required unless the SKs become irritated or the patient desires them removed for cosmetic reasons. __________ References: The prevalence of seborrheic keratoses in people 15 to 30 years: Is the term senile keratoses redundant? (http://www.ncbi.nlm.nih.gov/pubmed/10871940) Seborrheic keratoses and cancer. (http://www.ncbi.nlm.nih.gov/pubmed/1535080)

A 60-Year-Old Man Comes to the Physician with a Growth