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By Lawrence A. Schiffman, DO, and Stephen
M. Schleicher, MD
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CASE:
An 81-year-old, fair-skinned woman presents for evaluation of lesions that she has had for about two years on both legs. She admits to ample sun exposure in the past and has had a skin cancer removed from her face. Although the lesions are largely asymptomatic, several have bled following minor trauma. An examination of the patientŐs
legs reveals mild edema as well as multiple erythematous
patches and thin plaques of varying sizes.
WHAT IS YOUR DIAGNOSIS?
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Disseminated superficial actinic porokeratosis (DSAP) presents as multiple flat to barely elevated brownish-red patches on the extremities. The inheritance pattern of the disorder is autosomal dominant with variable penetrance. In genetically predisposed individuals, chronic sun exposure is implicated in the development of lesions, which tend to appear beginning in the fourth decade. Most cases can be diagnosed based on clinical appearance; histopathology will confirm the diagnosis. Uncommonly, DSAP may evolve into squamous cell carcinoma. Some lesions may respond to cryosurgery or topical application of 5-fluorouracil or imiquimod cream.
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Dr. Schleicher is director of DermDx Centers
and a clinical instructor of dermatology at the Philadelphia
College of Osteopathic Medicine, at Kings College in Wilkes-Barre,
Pennsylvania, and at Arcadia University in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE
editorial board. Dr. Schiffman is currently a resident at
St. John's Episcopal Hospital in Far Rockaway, New York.
Emerg Med 38(2):21, 2006
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