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April 2009

Recurrent Hypertrophic Nodules on the Bilateral Arms—Quiz Case

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Arch Dermatol. 2009;145(4):479-484. doi:10.1001/archdermatol.2009.34-a

A 49-year-old woman presented with a 1-year history of an 8 × 11-mm hyperkeratotic nodule on the dorsal side of her right hand (Figure 1). The patient had a medical history notable for discoid lupus erythematosus (DLE). The results of a previous biopsy of the right hand lesion had been interpreted as keratoacanthoma (KA) or squamous cell carcinoma (SCC). Despite multiple sessions of electrodessication and curettage and Mohs surgery with clear margins from multiple institutions, she continued to have local recurrences. During the next year, she developed hyperkeratotic nodules on her arms, chin, and lips. Biopsy specimens from the arm lesions were interpreted as KA or SCC, and surgery was suggested. The patient was referred for possible nonsurgical treatment for her recurring multiple KAs. The original pathologic specimen from the dorsal side of her hand is shown in Figure 2, with a Verhoff van Gieson stain in Figure 3.

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