These wounds occurred when this 77-year-old woman fell when chasing her dog. Such wounds—a combination of ecchymoses and erosion caused by blunt and sheering forces on fragile skin—are common in the elderly, even after relatively mild trauma. Simple interventions will promote healing.
These widely scattered, dome-shaped pruritic inflammatory papules suggest insect bites. A biopsy showed mixed dermal infiltrate consisting of lymphocytes and eosinophils, consistent with an arthropod assault.
The differential diagnostic possibilities for this tender nodule included hypertrophic actinic keratosis, keratoacanthoma, squamous cell carcinoma, and verruca. The possibility of squamous cell carcinoma dictated removal with histologic examination.
A multiplicity of colors in a pigmented lesion usually dictates the need for a biopsy. In this woman with many nevi and a history of malignant melanoma, biopsy revealed an inflamed blue nevus and was also curative.
The development of eccentric pigmentation within a previously stable pigmented lesion may indicate malignant degeneration, as was the case here. Of all melanomas, lentigo maligna melanoma has the best overall prognosis.
Round plaques like this one, each composed of many small erythematous papules, are classic for granuloma annulare. Large numbers of these lesions and widespread distribution is often associated with diabetes mellitus.