Spot Diagnosis

A 64-year-old Caucasian woman with a history of hypertension, rheumatoid arthritis and poorly controlled type II diabetes mellitus presents for evaluation of colour changes on her left foot.

A 3-year-old boy presented to the clinic with a dark spot in his hair that measured 3 cm by 3 cm. The skin in this region was lightly pigmented, with dark hairs; the lesion had been more pigmented at birth.

A 58-year-old healthy man was evaluated for a toothache of 2 days' duration. He was treated with oral penicillin and an opiate analgesic and advised to have the affected teeth pulled.

What is the diagnosis based on this image ?

A 62-year-old man reported acute left retro-orbital pain of one week's duration. Physical examination revealed no abnormalities. Three days later, double vision developed, and the next day a rash appeared on the forehead.

His medications were apixaban, ramipril, bisoprolol, amlodipine, and amiodarone. Physical examination showed discoloration of his nose, cheeks, and forehead.

A 7-year-old girl presented to the emergency department with a 2-week history of fever and with several days of painful blisters on her arms, legs, and face. Two weeks earlier, she had completed a course of penicillin for tonsillitis.

A 27-year-old primigravid woman was admitted with new-onset diabetes and hypertension at 32 weeks of gestation. She had worsening proximal muscle weakness, striae, and facial plethora for several months.

A 64-year-old man presented to the oral medicine clinic with a painful, smooth, red tongue and a burning sensation around his lips that had developed 6 months earlier. No deficits were found on neurologic examination.

A 42-year-old man who was undergoing treatment for non-Hodgkin’s lymphoma presented to the oncology clinic with changes in his fingernails. What is the most likely underlying cause of this presentation?