Search

Ultrasonography is an essential tool for most medical specialties; training in its use is required for dermatology residency programs in Germany. Ultrasonography is a versatile, painless, low-risk, non-invasive procedure which can be done anywhere and easily repeated; it provides real-time visual information about benign and malignant processes in the skin and subcutis. High frequency sonography with 20 MHz scanners is well-established for measuring the thickness of the skin or its tumors and assessing inflammatory skin disorders. Mid-frequency sonography with 7.5-15 MHz sounds is widely used in dermatologic oncology, both for pre-operative staging and follow-up of melanoma patients. The interpretation of sonographic images such as borders of lesions, echogenicity, artifacts and vascular patterns with duplex color sonography requires structured education and intensive training. The wide variety of diagnostic information provided by sonography underlines its essential position in certified skin cancer centers.

Focal epithelial hyperplasia (FEH) or Heck disease is a rare skin disease caused by human papilloma viruses (HPV). The case of a 9-year old boy is presented to demonstrate the successful treatment of massive FEH with 5% imiquimod cream. Initially, the patient had noticed several separate papules, which spread and developed into multiple peri- and intraoral papillomatous nodules. The lesions were treated with carbon dioxide laser destruction. However, multiple, skin-coloured papillomatous nodules were found on the tongue, buccal mucosa and lips 1.5 years later. Treatment with imiquimod was initiated, because the patient suffered tremendously from the disease. 5% imiquimod cream was applied 3 times per week. Regression of lesions was obvious after 1 month of treatment. Complete clearance was achieved after 2 additional months of treatment and no recurrence was detected over a follow-up period of 5 months. Our case points out the clinical value of imiquimod for the non-traumatic and almost painless therapy of HPV-induced skin diseases in children.