HPI: Patient is a 59-year-old male with a history of multiple sebaceous neoplasms and recurrent squamous cell carcinomas of the right forehead/supraorbital region and scalp status post Mohs micrographic surgery, re-excision, and radiation therapy, who presents for evaluation of two pruritic and irritating lesions on the back, present for 1-2 months. He also reports multiple other asymptomatic lesions, including a lesion on the umbilicus and left neck.
Past medical history: hyperlipidemia, hypothyroidism, GERD
Social Hx: Patient is recently retired, used to work as an engineer. Reports consuming a 12-pack of beer each weekend and smoking 1.5 packs-per-day for 30 years.
Family Hx: extensive family history of malignancy, including lung cancer in patient’s mother and colon cancer in patient’s father
Medications: Hydrocodone, Atorvastatin, Levothyroxine, Omeprazole, Vtamin B12, Melatonin
Physical examination: diffuse photodamage with numerous pink scaly papules and dome-shaped yellow-orange papules on the face, left lateral neck (Fig.1), multiple skin-colored to pink dome-shaped firm papules on the back (Fig. 2), and superior umbilicus. 8 mm ulcerated pink plaques on the upper and lower back (Fig.3).
Click here for the Diagnosis.