GP Quiz 5 - Case 1.
This 55-year-old man has had gradually increasing numbers of asymptomatic nodules on both forearms since he was in his twenties. His father and brother had similar lesions.
What is the diagnosis?
Multiple epidermal cysts.
What else should you look for?
Although in most cases of familial epidermal cysts there are no specific associations, a few patients have Gardner's syndrome. This is an association of epidermal cysts, osteomas, and fibromatous tumours associated with polyposis coli in which carcinomatous change is a frequent finding.
What further tests are necessary (if any)?
Biopsy of typical lesion to confirm the presence of a keratinous cyst. Consider colonoscopy, especially if there is a family history of polyposis coli or carcinoma of the colon.
What is the treatment?
Individual lesions may be incised and expressed, or excised. This is rarely necessary or appropriate when numerous lesions are present.
This quiz was originally published by ADIS International in September 1996