(BMJ) – A 33-yo man w/ dysplastic nevus syndrome presented w/ a 2-wk hx of pruritus and inflammation affecting a nevus on his thorax. Exam: erythematous scaly eruption encircling preexisting nevus. The inflammation completely resolved w/ topical steroid tx. What is the diagnosis?
Lichen sclerosus
Melanoma
Halo nevus
Basal cell carcinoma
Meyerson nevus
You are correct. Meyerson nevus, a benign condition which is distinct from dysplastic nevus syndrome, occurs when a nevus triggers a halo of eczematous inflammation. However, an important consideration in the differential diagnosis is melanoma. People w/ dysplastic nevus syndrome are at higher risk of malignant melanoma; in fact, pruritus, crusting, or inflammation involving a nevus are important warning signs for melanoma and should prompt an urgent consultation. In this case, however, the inflammation resolved w/ topical steroid tx, and melanoma was ruled out.
(BMJ)—A 50-yo nurse presented w/ spontaneous discoloration of her left ring finger, which followed a mild sense of pruritus shortly prior. She stated that this had occurred several times before. Labs and x-ray: normal. What is the diagnosis?
Buerger disease
Pigmented purpuric dermatosis
Paroxysmal finger hematoma
Repetitive strain injury
Raynaud phenomenon
You are correct. Paroxysmal finger hematoma, or Achenbach syndrome, is a rare, self-limiting condition of unknown etiology. Hematological and radiological investigations are often normal, and diagnosis is made on clinical grounds. The condition remits spontaneously, and no specific tx is needed. Recognition of Achenbach syndrome should prevent extensive unnecessary investigations.