robin082006
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A 35-year-old elementary school art teacher comes into the office worried about a growing lesion on her left thumb over the last 3-4 weeks. She recalls working with sharp knives and accidentally stabbing the thumb in sculpture class around the same time she noticed the lesion. She tells you that initially the lesion looked liked a small "pimple" which grew in size, bleeding when irritated, and has rough surfaces. She describes a "pulsing" tender sensation. Physical examination shows a 1.2 cm x 1.0 cm polypoid, soft, red mass constricted by a collarette at the base of the lesion located on the lateral nail fold of the left thumb. No pulse over the lesion is appreciated on palpation. The remainder of the cutaneous examination is unremarkable. The most appropriate next step is to
A. check HIV status because this is most likely Kaposi sarcoma
B. shave and electrodesiccate the base of the lesion and send the specimen to pathology for analysis
C. shave the lesion off and throw it away because it is a benign lesion
D. tell her this is an acquired hemangioma and it will involute on its own
E. tell her this is a fungal infection and you need to treat it with oral antifungal agents
Kap q
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| yasmeen
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D?
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| virgola82
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I have no clue.... I think I would go with B, at least the pathologist should make a clear diagnosis....
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| dermatology
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C ???? granuloma pyogenicum ????
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| arlete
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Sounds like C, granuloma pyogenicum.
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| step2ckjan07
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D
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| paasu
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we can't be very specific in the diagnosis as pyogenic granuloma although the history suggests.
b is the likely answer because unless u know the biopsy reports that rule out any sort of dysplasia we can not diagnose as pyogenic granuloma.
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| khorshid
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I guess as a rule you can't shave off something and throw it away (unless it's like a seborrheic keratosis for example), so I'll go with the option which sends it for pathology
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| oggn
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b
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| tongsaa
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Answer please?
I would say B
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| dr in trouble
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I think it shud b B.
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| dr_arc
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trivial trauma to dermis-----rapidly growing papule/nodule ---bleed when irritated = classic granuloma pyogenicum
shave and electrodessicate base to prevent
1)bleeding
2) recurrence
patho to confirm
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| cirus
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B
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