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Clinical Cases in Dermatopathology Guidelines

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Clinical Cases in Dermatopathology

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University Of The People

This series of concise practical guides is designed to facilitate the clinical decision-making process by reviewing a number of cases and defining the various diagnostic and management decisions open to clinicians. Each title is illustrated and diverse in scope, enabling the reader to obtain r...

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Uploaded on October 25, 2024
Number of pages 178
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Type Case
Professor(s) Dong-lin xie
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clinical cases in dermatopathology

Institution University Of The People
Course Clinical Cases in Dermatopathology

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Clinical Cases in Dermatology
Series Editor: Robert A. Norman

Dong-Lin Xie Editor

Clinical Cases in
Dermatopathology

,Clinical Cases in
Dermatology
Series Editor
Robert A. Norman
Tampa, FL, USA

,This series of concise practical guides is designed to facilitate
the clinical decision-making process by reviewing a number
of cases and defining the various diagnostic and management
decisions open to clinicians.
Each title is illustrated and diverse in scope, enabling the
reader to obtain relevant clinical information regarding both
standard and unusual cases in a rapid, easy to digest format.
Each focuses on one disease or patient group, and includes
common cases to allow readers to know they are doing things
right if they follow the case guidelines.

More information about this series at http://www.springer.
com/series/10473

,Dong-Lin Xie
Editor

Clinical Cases in
Dermatopathology

,Editor
Dong-Lin Xie
Ruffolo, Hooper & Associates, M.D, P.A.
Tampa, FL
USA

Clinical Cases in Dermatology
ISBN 978-3-030-28806-8 ISBN 978-3-030-28807-5 (eBook)
https://doi.org/10.1007/978-3-030-28807-5

© Springer Nature Switzerland AG 2020
This work is subject to copyright. All rights are reserved by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of transla-
tion, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on
microfilms or in any other physical way, and transmission or information storage
and retrieval, electronic adaptation, computer software, or by similar or dissimi-
lar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service
marks, etc. in this publication does not imply, even in the absence of a specific
statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and
information in this book are believed to be true and accurate at the date of pub-
lication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral
with regard to jurisdictional claims in published maps and institutional
affiliations.

This Springer imprint is published by the registered company Springer
Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

,Contents

1 Case 1: Skin Lesions of Trunk and Extremities,
Clinical R/O Scabies�� 1
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
2 Case 2: Leg Lesion with Clinical Impression:
Stasis vs. Skin Cancer�� 7
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
3 Case 3: Skin Lesions of Trunk and Extremities,
Clinical R/O Scabies�� 15
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
4 Case 4: Skin Lesion of Forehead,
Clinical Impression, R/O Foreign Object �� 19
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
5 Case 5: Skin Lesions of Forehead,
R/O Sebaceoma �� 25
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
6 Case 6: Skin Lesion of Right Lower Leg,
R/O Vitiligo�� 35
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
7 Case 7: Skin of Scalp, R/O Tinea vs.
Seborrheic Dermatitis �� 41
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
8 Case 8: Skin Lesion of Abdomen,
Clinically Elevated�� 49
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman

,vi Contents

9 Case 9: Skin of Right Inferior Eyelid Lesion,
R/O Seborrheic Keratosis�� 55
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
10 Case 10: Four-Year-Old Female with Left
Lateral Trunk Lesions �� 61
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
11 Case 11: Skin Lesion Left Upper Arm, R/O Cyst�� 69
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
12 Case 12: Skin of Back, R/O Cancer vs.
Dermatitis, vs. Tinea�� 75
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
13 Case 13: Skin of Right Wrist,
R/O Foreign Object�� 83
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
14 Case 14: Left Parietal Skin,
R/O Dysplastic Nevus �� 89
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
15 Case 15: Skin of Mid Lateral Back,
R/O Fibroma�� 97
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
16 Case 16: Skin of Upper Abdomen,
R/O Squamous Cell Carcinoma vs.
Basal Cell Carcinoma�� 103
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
17 Case 17: Skin of Upper Paraspinal Lesion,
R/O Miliaria Rubra vs. Atopic Dermatitis �� 109
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
18 Case 18: Skin Right Forearm, R/O Rhus Derm �� 115
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
19 Case 19: Left Mandible Skin, R/O Basal
Cell Carcinoma vs. Cyst�� 121
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman

, Contents vii

20 Case 20: Occipital Scalp Skin, R/O Squamous
Cell Carcinoma�� 129
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
21 Case 21: Skin from Mid-Forehead,
R/O Verruca Vulgaris�� 137
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman
22 Case 22: Right Upper Arm Lesion�� 143
Dong-Lin Xie, Emelia Farnsworth, and
Robert A. Norman
23 Case 23: Right Arm Papules�� 151
Dong-Lin Xie, Emelia Farnsworth, and
Robert A. Norman
24 Case 24: Nodular Masses on Left Fingertips�� 163
Dong-Lin Xie, Emelia Farnsworth, and
Robert A. Norman
25 Case 25: Diffuse Rashes Across Back, Thighs,
and Legs�� 171
Dong-Lin Xie, Emelia Farnsworth, and
Robert A. Norman
Index�� 179

,Chapter 1
Case 1: Skin Lesions
of Trunk and Extremities,
Clinical R/O Scabies
Dong-Lin Xie, Tam H. Nguyen, and Robert A. Norman

History and Clinical
A 92-year-old male with a history of hemiplegia and hemipa-
resis following a cerebrovascular accident presented in the
nursing home with a widespread rash for several weeks.
Nursing home staff noted the patient was scratching
throughout the day, but it would become significantly worse
during the night. The patient had no history of similar skin
complaints.

D.-L. Xie (*)
Ruffolo, Hooper & Associates, M.D, P.A., Tampa, FL, USA
e-mail:
T. H. Nguyen
DO, PGY-1 Larkin Community Hospital, Miami, FL, USA
R. A. Norman
Department of Dermatology, Nova Southeastern University,
Tampa, FL, USA
Center for Geriatric Dermatology and Neuro-Dermatology,
Tampa, FL, USA

© Springer Nature Switzerland AG 2020 1
D.-L. Xie (ed.), Clinical Cases in Dermatopathology,
Clinical Cases in Dermatology,
https://doi.org/10.1007/978-3-030-28807-5_1

, 2 D.-L. Xie et al.

Physical Examination
The patient had a diffuse, erythematous papular rash on his
trunk and groin. Overlying areas of linear excoriations were
noted as well on the trunk and folds of the groin. Very dis-
crete linear burrows were also seen between the interdigital
spaces of his right and left hands.

Clinical Differential Diagnosis
• Insect bites
• Atopic Dermatitis
• Neurotic Excoriations
• Scabies
• Drug Reaction

Histopathology

Spongiotic epidermal changes with marked mixed perivascu-
lar and interstitial inflammatory cells of lymphocytes, histio-
cytes, abundant eosinophils and occasional neutrophils are
present (Fig. 1.1).
Hyperkeratosis and parakeratosis with neutrophils are
seen in the stratum corneum. Organisms and material mor-
phologically consistent with scabies and scabies products are
identified (Figs. 1.2 and 1.3).
In addition, PAS stain reveals fungal hyphae in the in the
stratum corneum (Fig. 1.4).

Final Diagnosis

–– Scabies infestation.
–– Dermatophytosis.

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