Concerned about skin cancer, a 70-year-old woman presents to dermatology for evaluation. She spent a great deal of time in the sun when she was younger and didn’t tolerate it well, although she has never received a diagnosis of skin cancer.
The examination uncovers no worrisome lesions in that regard, but several other long-standing findings are noted. On the patient’s right arm, many clear, firm intradermal nodules and freckles are evident.
The patient’s history includes several benign but troublesome tumors—among them, a pheochromocytoma and a brain tumor that required surgery. She has also had seizures (now controlled with medication) and hypertension (which resolved with the removal of her pheochromocytoma). No one else in her family, including her grown children, has experienced a similar skin condition.