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CME Dermatology Clinic
CE ■ LEARNING OBJECTIVES: To increase awareness of dermatologic conditions, their
diagnosis, and up-to-date treatment.
■ COMPLETE THE POSTTEST: Page 67 ■ ADDITIONAL CME/CE: Pages 17, 63
Shiny, waxy patches
on the shins
BY CRAIG G. BURKHART, MD, MPH
A 24-year-old woman with type 2 diabetes presented with recent
onset of asymptomatic, shiny, waxy, round patches on her shins.
Initially reddish-brown in color, the patches were now yellow. Each
patch had a palpable peripheral rim and an atrophic center with visible
telangiectasias. Recently, after the patient hit her leg on the corner of a
table, a slow-healing erosion developed at the site. The patient reported
no blisters or infection associated with the lesions. Additionally, she
reported no retinopathy, microalbuminuria, or neuropathy.
What is your diagnosis? Turn to page 46
Rapidly growing tumor
on the forearm
BY TRAVIS VANDERGRIFF, MD
A 54-year-old Caucasian man presented to the dermatology clinic
for evaluation of a tumor on his right forearm. A small “red bump”
that ﬁrst appeared about six weeks earlier had grown rapidly and
developed a crusted center. The patient recalled no preceding trauma
to the site and had no personal or family history of skin cancer. The
lesion had not yet been treated. On examination, a 1.5-cm, ery-
thematous, crater-shaped nodule was visible on the right forearm.
The indurated nodule had rolled borders and a central hyperkera-
totic core. There was no regional lymphadenopathy. Shave biopsy
revealed a well-differentiated squamous cell neoplasm with glassy
keratinocytes and a central core of hyperkeratosis.
What is your diagnosis? Turn to page 47
www.clinicaladvisor.com • THE CLINICAL ADVISOR • APRIL 2010 45
M and A, as well as complement 3 and ﬁbrinogen in the References
blood-vessel walls. 1. Burkhart CG, Burkhart CN. Propionibacterium acnes: an indigenous
No treatment has been proven to be effective in large bacterium may be pathogenic in several cutaneous disease states. Arch
clinical studies. As previously noted, control of blood glucose Dermatol. 2001:137:1250.
levels in diabetic patients does not have a signiﬁcant effect 2. Landers MC, Skokan M, Law S. Storrs F. Cutaneous and pulmonary
on the course of NL. Protecti