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Mixed diagnoses – 10 cases (10 of 11)

For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately five minutes to complete. There is a list of suggested further reading material at the end of the quiz.

When you finish the quiz, you can download a certificate.

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.

Multiple epidermal cysts.

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.

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.

Individual lesions may be incised and expressed, or excised. This is rarely necessary or appropriate when numerous lesions are present.

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