23155491 Visualization

A 57 Age - year Age - old Age Jewish Personal_background man Sex with Crohn's Disease_disorder disease Disease_disorder ( CD Disease_disorder ) of the ileum Biological_structure diagnosed at the age Date of Date thirteen Date , presented Clinical_event with multiple Detailed_description nonmelanoma Disease_disorder skin Disease_disorder cancers Disease_disorder ( NMSCs Disease_disorder ); these had developed over Duration the Duration past Duration 16 Duration years Duration coinciding with the initiation of a prolonged Dosage course Dosage of the thiopurine Medication 6 Medication - mercaptopurine Medication ( mercaptopurine Medication , 6 Medication - MP Medication ).
He was diagnosed with a total of 84 Lab_value NMSC Disease_disorder : 72 Lab_value NMSC Coreference at our Nonbiological_location clinic Nonbiological_location , 12 Lab_value from other Nonbiological_location clinics Nonbiological_location .
He was also awaiting biopsy Diagnostic_procedure and removal Therapeutic_procedure for additional lesions Sign_symptom .
His CD Disease_disorder was initially treated with sulfasalazine Medication and intermittent Frequency steroids Medication at diagnosis, but for the past Duration 20 Duration years Duration he had been taking 6 Medication - MP Medication daily Frequency .
In the first Duration ten Duration years Duration after beginning 6 Medication - MP Medication he developed 30 Lab_value NMSC Disease_disorder ; 14 Lab_value were squamous Disease_disorder cell Disease_disorder carcinoma Disease_disorder ( SCC Disease_disorder ) and 16 Lab_value were basal Disease_disorder cell Disease_disorder carcinoma Disease_disorder ( BCC Disease_disorder ).
The patient was then treated Therapeutic_procedure elsewhere Nonbiological_location for the subsequent Duration ten Duration years Duration .
This past Date year Date , however, he returned Clinical_event to the clinic Nonbiological_location with over 100 Lab_value new Lab_value lesions Sign_symptom suggestive of malignancy Disease_disorder on his torso Biological_structure and extremities Biological_structure .
Subsequent to this exam, he had 42 Lab_value biopsy Diagnostic_procedure -proven lesions Sign_symptom of NMCS Disease_disorder ; 20 Lab_value were SCC Disease_disorder and 22 Lab_value were BCC Disease_disorder .
In addition, three Lab_value of the SCCs Disease_disorder were moderately Lab_value differentiated Lab_value and two Lab_value were poorly Lab_value differentiated Lab_value and some of his larger skin Disease_disorder cancers Disease_disorder have necessitated Mohs Therapeutic_procedure surgery Therapeutic_procedure and xenografting Therapeutic_procedure .
The largest Lab_value of his lesions Sign_symptom was pretibial Biological_structure and measured 64x53 Area mm Area (Figure 1).
He was awaiting biopsy Diagnostic_procedure for many other suspicious lesions.
The patient had Fitzpatrick Lab_value II Lab_value skin Diagnostic_procedure type Diagnostic_procedure and admitted to excessive Detailed_description sun Activity exposure Activity for History 25 Duration years Duration in Hawai‘i Nonbiological_location .
Early Date on Date he did History not History use History sunscreen History , and would sail Activity a History catamaran Detailed_description during Detailed_description peak Detailed_description sun Detailed_description hours Detailed_description .
He also revealed that his mother Family_history had Family_history one Detailed_description skin Detailed_description cancer Detailed_description lesion Detailed_description removed Detailed_description and denied History ever History having History been History a History smoker Activity .
Within the past Date year Date he discontinued 6 Medication - MP Medication and began using mesalamine Medication ( Pentasa Medication ) and later adalimumab Medication ( Humira Medication ) hoping to attenuate the progression of NMSC, and continued to have monthly Frequency skin Diagnostic_procedure exams Diagnostic_procedure .
Overall, he was hospitalized Clinical_event 16 Lab_value times Lab_value for his CD Disease_disorder , but never required any intestinal Biological_structure resection Therapeutic_procedure .
Unfortunately, in his most recent hospitalization Clinical_event he was diagnosed with metastatic Detailed_description adenocarcinoma Disease_disorder of the small Biological_structure bowel Biological_structure , and passed Outcome away Outcome shortly Date after Date .