Common Skin Cancers

Chapter 53 Common Skin Cancers




Clinical Case Problem 1 An Elderly Man with Long Sun Exposure


A 60-year-old man presents to your office with multiple scaly lesions on his ears, face, forearms, and hands. He states that he worked in construction most of his life and was exposed to the sun almost every day. He reports that he never used sunscreens and often did not wear shirts. He denied any previous history of skin cancers. He states that some of these lesions would come off by themselves but often would recur and persist. On examination, you notice multiple small, slightly reddish, scaly macules on the forehead, top of ears, forearms, and back of the hands. On his right ear, you notice a small, firm, slightly reddish, slightly scaly nodule. The patient states that the lesion had been slowly growing during the past 2   years. The patient states that the lesion on the ear would occasionally become tender and would scab and re-scab.



Select the best answer to the following questions




1. What is the most likely cause of the lesions on the forehead, top of ears, forearms, and back of hands?


a. papular eczema

b. psoriasis

c. actinic keratosis

d. nummular eczema

e. none of the above

2. If left untreated, what might the lesions on the forehead, top of ears, forearms, and back of hands become?


a. infected

b. no change

c. squamous cell carcinoma

d. basal cell carcinoma

e. c and d

3. The small scaly nodule on the right ear is most consistent with what lesion(s)?


a. chondrodermatitis nodularis helicis

b. basal cell carcinoma

c. squamous cell carcinoma

d. b and c

e. all of the above

4. What is the treatment of choice for the lesion on the right ear?


a. wide excision

b. Mohs micrographic surgery

c. curettage and electrodesiccation

d. cryotherapy

e. imiquimod


Clinical Case Problem 2 An Enlarging Facial Lesion


A 58-year-old woman presents to your office for general skin examination and skin cancer screening. Her skin examination was unremarkable except for a small whitish, scar-like lesion on the left side of the forehead. On further inquiry, the patient admitted that the lesion had been present for about 5   years, very slowly enlarging. She thought it was just scar tissue from working in her garden, although she recalls no specific trauma. On examination, you notice a 1.5-cm, ill-defined, whitish, thickened area of skin.



5. What would be the differential diagnosis for this lesion on the left side of the forehead?


a. lichen sclerosus

b. basal cell carcinoma, morphea type

c. scar tissue

d. atypical nonpigmented melanoma

e. lichen planus

f. all except d

g. all of the above

6. How should this lesion be managed?


a. shave biopsy to determine type of lesion

b. proceed with Mohs micrographic surgery

c. curettage and electrodesiccation

d. cryotherapy

e. imiquimod therapy



Clinical Case Problem 3 Wartlike Lesions under the Breast


A 65-year-old woman presents to your office complaining of ugly brown wart-type lesions that are starting to develop on her chest and under her breasts. She also reports similar lesions on her back. She states that her mother and father were covered with these lesions. She denied any family history of skin cancers including melanomas. She admits to excessive sun exposure in her teenage years with several severe sunburns. She also admitted to use of tanning booths in the winter months. On examination, you notice she has red hair, blue eyes, and fairly tanned skin. Examination of her chest, back, and trunk reveals numerous solar lentigines and freckles with dozens of small brown, warty lesions. On close inspection, you see a large lentigo on the left upper breast with a dark, raised lesion (7   mm) on the edge of the lentigo. The patient states that she had not paid attention to it because she thought it looked like the rest of her brown spots.



7. What is the best approach to this lesion on the left upper breast?


a. log the measurement, observe, and recheck in 3   months

b. punch biopsy

c. excisional biopsy

d. shave biopsy

e. send patient to oncologist as soon as possible

8. What would be your differential diagnosis for this lesion?


a. smooth seborrheic keratosis

b. blue nevus

c. lentigo maligna melanoma

d. dysplastic nevus

e. all of the above

f. all of the above except b

9. Without alarming the patient, how would you answer her question on her prognosis?


a. defer answering until the pathology report is obtained

b. inform her that female patients and younger patients usually have a better prognosis

c. inform her that melanomas on the extremities have a worse prognosis than melanomas on the head, neck, face, and trunk

d. all of the above except c

e. none of the above

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Common Skin Cancers

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