Chapter 23 Pigmented Skin Lesion in a 58-Year-Old Female (Case 12)
Basal cell carcinoma | Malignant melanoma | Actinic keratosis |
Squamous cell carcinoma | Atypical nevus | Benign nevus |
PATIENT CARE
Clinical Thinking
• Different pigmented skin lesions present differently and often atypically. Melanoma must be excluded.
History
Of particular interest in patients presenting with a skin lesion are the following:
• Geographic location: Patients who spend a significant amount of time in sunbelts around the world are at increased risk.
• Medications: Topical acne medications may predispose to skin sloughing and anticoagulants may affect surgical planning.
• Immune status: Patients with HIV, AIDS, those on immunosuppression, or individuals with repeated skin sloughing from bullous disease, decubitus ulcers, or Marjolin’s ulcers all have an increased risk for developing malignant lesions.
Physical Examination
• The age and gender of a patient contributes to the likelihood of malignancy. Men most often have melanoma on the trunk while women have it on the lower extremities.
• A complete skin examination in a well-lighted room includes inspection from the scalp to the toes, paying careful attention to those areas most notable for harboring cutaneous malignancies, such as the face, neck, upper back, upper and lower extremities, plus both dorsal and ventral aspects of the hands and feet.
• Document the anatomic location, size, shape, color (pigmentation), presence or absence of ulceration, blanching, bleeding, or evidence of inflammation (ABCDE of melanoma) for all skin lesions of concern.
• The findings of Asymmetry, Border irregularity, variegated Colors, larger Diameter (>5 mm), or Erythema raise the suspicion for malignancy.
Tests for Consideration
The following tests should be considered when planning biopsy of a skin lesion:
The following tests should be considered when planning a lymph node biopsy:
$1,000 | |
$650 |
The following tests should be considered when working up a biopsy-proven melanoma: | |
$75 | |
$1,500 | |
→ Positron emission tomography (PET): The positron-emitting isotope of glucose is highly sensitive to melanoma. Hour-long scanning of the entire body should be purposely modified to evaluate skin and deep tissues.
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