Dermatology Clinic: Questions and Answers
Case 1
1. What is your diagnosis?
This patient exhibits signs and symptoms of iatrogenic Cushing syndrome with steroid acne due to corticosteroid withdrawal.
2. What factors may have contributed to the disease?
The chronic treatment with high doses of prednisone contributed to the patient’s Cushing syndrome. However, steroid withdrawal may have caused her recent skin flare around her trunk and extremities.
3. What is the treatment of choice for this condition?
According to Igaz, Rácz, Tóth, Gláz, and Tulassay (2007), the longer the time of steroid treatment and the higher the dose applied, the longer the time needed for withdrawal. They add that in the case of steroid withdrawal syndrome, glucocorticoid …show more content…
The diameter appears to be greater than 6 millimeters. Furthermore, Chuck has history of increased sun exposure due to his job. Given the patient’s presentation, the most likely diagnosis is cutaneous malignant melanoma.
2. If your primary diagnosis is incorrect, what else could it be?
If Chuck’s lesion is not cutaneous malignant melanoma then the lesion could also be a dysplastic nevi, vascular skin tumor, seborrheic keratosis, or pigmented actinic keratosis.
3. What is your immediate plan of action?
The immediate plan of action is to perform a biopsy of the lesion.
4. If your initial diagnosis is correct, what is his likely treatment and prognosis?
In the case of cutaneous malignant melanoma, a complete surgical excision would be the standard of care. In addition, it is important to determine if systemic treatment with chemotherapy is necessary upon evaluation of pathological staging results. Close monitoring every 3-6 months is essential in patients with history of melanoma to prevent recurrence. The 5-year survival rate of early stage melanoma is 97%. However, metastatic melanoma has a survival of 6-9 months (Duman, 2014).
5. Did Chuck win or lose the $50
Case 1
1. What is your diagnosis?
This patient exhibits signs and symptoms of iatrogenic Cushing syndrome with steroid acne due to corticosteroid withdrawal.
2. What factors may have contributed to the disease?
The chronic treatment with high doses of prednisone contributed to the patient’s Cushing syndrome. However, steroid withdrawal may have caused her recent skin flare around her trunk and extremities.
3. What is the treatment of choice for this condition?
According to Igaz, Rácz, Tóth, Gláz, and Tulassay (2007), the longer the time of steroid treatment and the higher the dose applied, the longer the time needed for withdrawal. They add that in the case of steroid withdrawal syndrome, glucocorticoid …show more content…
The diameter appears to be greater than 6 millimeters. Furthermore, Chuck has history of increased sun exposure due to his job. Given the patient’s presentation, the most likely diagnosis is cutaneous malignant melanoma.
2. If your primary diagnosis is incorrect, what else could it be?
If Chuck’s lesion is not cutaneous malignant melanoma then the lesion could also be a dysplastic nevi, vascular skin tumor, seborrheic keratosis, or pigmented actinic keratosis.
3. What is your immediate plan of action?
The immediate plan of action is to perform a biopsy of the lesion.
4. If your initial diagnosis is correct, what is his likely treatment and prognosis?
In the case of cutaneous malignant melanoma, a complete surgical excision would be the standard of care. In addition, it is important to determine if systemic treatment with chemotherapy is necessary upon evaluation of pathological staging results. Close monitoring every 3-6 months is essential in patients with history of melanoma to prevent recurrence. The 5-year survival rate of early stage melanoma is 97%. However, metastatic melanoma has a survival of 6-9 months (Duman, 2014).
5. Did Chuck win or lose the $50