Acta Dermato-Venereologica Issue 8, 2017 97-8CompleteContent | Page 32

993 Multiple, Fine, Firm Keratotic Papules on the Palms: A Quiz Aline SCHÖLLER and Cyrill GÉRAUD* Department of Dermatology, Venereology and Allergy, University Medical Center and Medical Faculty Mannheim, Heidelberg University, Theo- dor-Kutzer-Ufer 1–3, DE-68135 Mannheim, Germany. *E-mail: [email protected] A 79-year-old man presented for treatment of a biopsy- proven atypical fibroxanthoma of the scalp. In addition, he had a 34-year history of asymptomatic spiny small skin lesions on both palms. Apart from a slightly rough feeling on the palms he reported no associated symptoms and the family history was negative for similar palmar lesions. His past medical history included hypertension, hyperlipidae- mia, coronary artery disease and restless legs syndrome. Besides the erythematous nodule on the scalp, numerous, firm, yellowish, spiky, keratotic papules, 1–2 mm in height were found on both palms (Fig. 1 A, B). The soles of his feet and the rest of the body were not affected by similar lesions. A punch biopsy was taken from the left hand (Fig. 1 C, D). Histology revealed columnar hyperkeratosis with ortho- and parakeratosis with underlying hypogranulosis. Due to the fact that the lesions were asymptomatic the patient refused treatment. What is your diagnosis? See next page for answer. Fig. 1. Clinical and histopathological findings. (A, B) Multiple, fine, firm, yellowish keratotic papules on the left palm. (C, D) Histopathological examination revealed a well-defined column of hyperparakeratosis above a fine granular layer. No dyskeratosis or vacuolization of the underlying epidermal keratinocytes was seen. The surrounding epidermis appeared normal with an unremarkable corneal layer (C: H&E x 100, D: x 400). QUIZ SECTION This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340/00015555-2679 Acta Derm Venereol 2017; 97: 993–994