OSCE — Sebaceous hyperplasia

Brief (to candidate)

You will assess a patient with a presentation consistent with Sebaceous hyperplasia.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Sebaceous hyperplasia is a common, benign, age-related proliferation of mature sebaceous glands presenting as small (2–9 mm), soft, yellowish papules with a characteristic central dell (umbilication) on the face of middle-aged to older adults. Histology shows enlarged, mature sebaceous lobules arranged around a central dilated duct. The key clinical challenge is distinguishing it from nodular basal cell carcinoma (both are pearly papules on sun-exposed skin of older adults). Dermoscopy shows the pathognomonic crown vessels, yellow-white lobules (cumulus sign) and central umbilication (bonbon toffee sign). Treatment is cosmetic: cryotherapy, electrodessication, CO2 / Er:YAG / pulsed-dye laser

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).
8. Give immediate resuscitation steps.
9. Outline definitive management with doses/routes where standard.
10. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
11. Mention one special-population modifier (pregnancy, child, elderly, CKD).

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]