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GENERAL INSTRUCTIONS

General Instructions:

You will find a list of True/False statements following each case history. Select any statements, which you believe to be true. There may be one, more than one, or no true statements for any given case. Choose the correct risk, diagnosis, and disposition for each case. Then, turn the page to find a detailed discussion and pearls for each case.

CASE 1

CASE 1 HISTORY

The parents of this 5-year-old girl noticed a dark spot on her palm.

  1. There is asymmetry of color and structure and the malignant parallel ridge pattern (PRP).

  2. The parallel brown lines are in the furrows of the skin diagnosing the malignant parallel furrow pattern.

  3. The parallel brown lines are in the furrows of the skin diagnosing the benign parallel furrow pattern.

  4. The parallel furrow pattern is the most common benign pattern found on glabrous skin.

  5. The parallel furrow pattern is the most common benign pattern found on nonglabrous skin.

RISK

  • ☐ Low

  • ☐ Intermediate

  • ☐ High

DIAGNOSIS

  • ☐ Nevus

  • ☐ Seborrheic keratosis

  • ☐ Basal cell carcinoma

  • ☐ Vascular

  • ☐ Dermatofibroma

  • ☐ Squamous cell carcinoma

  • ☐ Melanoma

  • ☐ Other

DISPOSITION

  • ☐ No intervention

  • ☐ Follow-up

  • ☐ Histopathologic diagnosis

RISK

  • ☑ Low

  • ☐ Intermediate

  • ☐ High

DIAGNOSIS

  • ☑ Nevus

  • ☐ Seborrheic keratosis

  • ☐ Basal cell carcinoma

  • ☐ Vascular

  • ☐ Dermatofibroma

  • ☐ Squamous cell carcinoma

  • ☐ Melanoma

  • ☐ Other

DISPOSITION

  • ☐ No intervention

  • ☑ Follow-up

  • ☐ Histopathologic diagnosis

DERMOSCOPIC CRITERIA

  • Symmetry of color and structure

  • Parallel furrow pattern

    • Furrows (white arrows)

    • Ridges (yellow arrows)

    • Acrosyringia (black arrows)

ANSWERS

Answers: 3,4

Discussion:

  • There is perfect symmetry of color and structure.

  • This nevus is on the volar surface of the hand (ie, glabrous skin).

    • Glabrous skin is non–hair-bearing skin.

  • The unique anatomy of the skin on the palms and soles with its distinctive dermatoglyphic pattern is made up of ridges (gyri) and furrows (sulci or fissures) that create parallel site-specific patterns.

    • Parallel patterns can also be found on mucosal surfaces.

  • The parallel brown lines are in the furrows of the skin creating the benign parallel furrow pattern.

    • This is the most common benign pattern seen on glabrous skin.

    • There is no such entity as the malignant parallel furrow pattern.

    • The ridges and furrows can be seen clinically, which is a clue to the dermoscopic pattern.

  • The lighter, hypopigmented parallel lines represent the ridges of the skin:

    • When pigmentation is found in the ridges that creates the parallel ridge pattern (PRP), ...

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