Comprehensive Dermatologic Care: Cyst, Wart, and Actinic Keratosis Treatment in a 74-Year-Old Female
By: Dr. Caroline Vaughn
At Village Dermatology, we specialize in diagnosing and treating a wide variety of skin concerns in patients of all ages. In this blog, we highlight a recent case of a 74-year-old female who came to our clinic with three skin concerns: an enlarging cyst on the right shoulder, a wart on the right index finger, and a sun-induced precancerous lesion known as actinic keratosis on the nose.
Patient Overview
The patient, new to our clinic, had been living with these lesions for years. Recently, the cyst began to enlarge, prompting her visit. The wart was asymptomatic, and the actinic keratosis on her nose was noted during routine examination.
1. Epidermal Inclusion Cyst (Right Posterior Shoulder)
Epidermal inclusion cysts are benign sacs under the skin filled with keratin. Though typically harmless, they can become painful, inflamed, or cosmetically concerning as they grow.
Exam Findings:
Location: Right posterior shoulder
Size: 1.1 cm × 1.2 cm
Appearance: Enlarging, firm, subcutaneous nodule
Treatment:
Slit Excision under local anesthesia
Entire cyst was removed and sent for pathology
Wound closed with simple repair using sutures
Patient was instructed to avoid heavy lifting or swimming for 14 days
Suture removal planned in 2 weeks
Why this matters:
Even benign cysts can enlarge or become inflamed, making excision a preventive and therapeutic option—especially in older adults.
2. Verruca Vulgaris (Common Wart on Right Index Finger)
Warts are caused by the human papillomavirus (HPV) and are contagious through direct contact. This patient’s wart had been present for years and had begun to enlarge.
Exam Findings:
Location: Right distal palmar index finger
Symptoms: Asymptomatic but enlarging and slightly irritated
Appearance: Classic cauliflower-like bump
Treatment:
One lesion treated using two freeze-thaw cycles
Patient education: Warts are contagious and may recur without continued treatment
Prevention Tip:
Avoid picking at warts and wash hands regularly to prevent spreading the virus.
3. Actinic Keratosis (Precancerous Lesion on Nasal Dorsum)
Actinic keratoses (AKs) are precancerous lesions that develop in sun-damaged skin. They can evolve into squamous cell carcinoma if left untreated.
Exam Findings:
Location: Nasal dorsum (bridge of the nose)
Appearance: Rough, scaly patch in sun-exposed area
Treatment:
Cryotherapy with liquid nitrogen
Patient was counseled on sun protection and SPF 30+ sunscreen
Discussed long-term treatment options including topical 5-FU, imiquimod, or photodynamic therapy
Comprehensive Geriatric Dermatology at Village Dermatology
This case showcases how one visit can lead to the diagnosis and treatment of multiple skin conditions in a senior patient. At Village Dermatology, we provide full-spectrum dermatologic care tailored to the unique needs of older adults, from benign lesions to cancer prevention.
If you’re noticing enlarging bumps, persistent growths, or sun-damaged skin, schedule a visit with our dermatology team in Katy or Houston, Texas.
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