Are These Lesions Getting Out of Hand?
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Joe R. Monroe, MPAS, PA, ­practices at Dermatology Associates of Oklahoma in Tulsa. He is also the founder of the Society of Dermatology Phyisican Assistants.

For 40 years, this 60-year-old woman has had lesions on the dorsum of her right hand. She worries they could be cancerous. Will your diagnosis ease her fear?

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Are These Lesions Getting Out of Hand?

For the past 40 years, a 60-year-old woman in otherwise decent health has had lesions on the dorsum of her right hand. They didn’t worry her until recently, when a relative suggested they might be “cancerous” and she should “have them checked out.” Her primary care provider repeatedly assured her that the lesions are benign, but her fears weren’t allayed and she is referred to dermatology.

Aside from mild hypertension, there is little else to report. She has received regular eye examinations for at least 20 years. Her family history is free of any hereditary conditions, although heart disease is all too common. There is no personal or family history of cancer.

Examination reveals about 6 lesions on the dorsum of her right hand. They are 3 to 7 mm, skin-colored, highly compressible, roughly round, and nontender to touch. No other lesions can be found.

Because of the patient’s concern that the lesions are cancerous, one is very easily shaved off flush with the skin. The sample is submitted to pathology; the report indicates a benign tumor composed of non-myelinating Schwann cells intermixed with neural axons.

The most likely diagnosis is

Neurofibromatosis type I

Neurofibromatosis type II

Giant cell tumors

Simple neurofibroma

Clinician Reviews. 2019 February;29(2):4e-5e

This quiz is not accredited for CME.

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