A 35-year-old man presents with multiple flat, scaly, hypopigmented macules and thin papules on his face, neck, and upper extremities. He has been getting more of these lesions over the years and has a sibling with similar findings.  A skin biopsy is performed, and histologic examination reveals hyperkeratosis, acanthosis, and large cells with a blue-grey pallor. Which of the following is the most appropriate management plan for this condition?

A. Initiate oral antifungal therapy and topical selenium sulfide

B. Cryotherapy for all visible lesions

C. Regular skin checks and sun protection education

D. Topical retinoid for visible lesions

Rationale:

This question assesses understanding of the management of epidermodysplasia verruciformis (EV), a rare genetic disorder associated with HPV susceptibility and an increased risk of nonmelanoma skin cancer (NMSC). Most patients have genetic mutations in EVER1 and EVER2.  Management focuses on minimizing risk factors for skin cancer and regular monitoring for early detection.

Correct answer: C. Regular skin checks and sun protection education.

Patients with EV are at high risk for NMSC due to chronic HPV infection and UV-induced mutations. Emphasizing sun protection and undergoing routine skin examinations for early detection and treatment of skin cancers is the cornerstone of management.

Incorrect answer choices:

A. Initiating oral antifungal therapy and topical selenium sulfide is the treatment for tinea versicolor, which can present with hypopigmented macules but is unrelated to EV. No fungal organisms were noted on biopsy. 

B. Cryotherapy may be used selectively for symptomatic or cosmetically concerning lesions but is not a primary management strategy for EV. Routine use does not address the underlying risk of NMSC.

D. Topical retinoids and oral retinoids can be utilized and may help decrease the lesion size and number of lesions for some patients. Recurrence is expected with discontinuation.