Facial Papules in a Young Woman With a History of Pancreatic and Parathyroid Surgery: Challenge
A 42-year-old woman attended a dermatologist for investigation of multiple papules on her face and neck of 4 months' duration. The lesions were primarily of cosmetic concern although some were mildly pruritic. Her medical history included a partial pancreatectomy for removal of multiple benign pancreatic neuroendocrine tumors and tumorlets, and surgical excision of 2 hyperplastic parathyroid glands. She was also known to have benign cystic thyroid nodules. Her medications included vitamin D and a proton pump inhibitor. On examination, multiple discrete 3- to 4-mm red papules were observed on the nose and upper lip, in addition to several white firm papules, up to 4 mm in diameter, on the cheeks (Fig. 1), neck, and chest. The latter generated a clinical suspicion of adnexal tumors, and a punch biopsy of a lesion on the cheek was obtained. The histopathological diagnosis was of a perifollicular scar. The red papules on the nose were regarded as angiofibromas clinically and, based on a shave biopsy 2 months later, this diagnosis was confirmed microscopically. The patient was then referred to a plastic surgeon for cosmetic management. He removed 3 of the white papules, one from the neck, and 2 from the right cheek by the punch technique.