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WWW.MDEDGE.COM/DERMATOLOGY PLEASE TURN TO PAGE E21 FOR THE DIAGNOSIS A 28-year-old woman presented for evaluation of a pearly papule on the forehead of several months’ duration that was concerning for basal cell carcinoma (BCC). She had a history of numerous BCCs starting at the age of 17 years. She denied radiation or other carcinogenic exposures and had no other notable medical history. The patient’s mother and grandmother also had numerous BCCs. Physical examination revealed hypotrichosis; numerous 3to 5-mm white cystic papules on the face, chest, and upper arms; and 1to 5-mm pitted depressions on the dorsal aspects of the hands (top) and extensor surfaces of the elbows (bottom). A proliferation of basaloid cells with peripheral palisading was seen on histopathologic evaluation. Genetic testing revealed no protein patched homolog 1, PTCH1, or suppressor of fused homolog, SUFU, gene mutations.

Pitted Depressions on the Hands and Elbows