A 48-year-old woman comes to the office due to a lesion on her neck. The lesion has been present for the past 6 months and is slowly enlarging. Skin findings are shown in the image below. Which of the following is the most likely diagnosis?

Question

A 48-year-old woman comes to the office due to a lesion on her neck.  The lesion has been present for the past 6 months and is slowly enlarging.  Skin findings are shown in the image below.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d383_7f43_bc81_c741f495ded8_MD0003_00 This patient has a slow-growing, ulcerated, pearly nodule with a rolled border on sun-exposed skin, typical features of basal cell carcinoma (BCC). BCC accounts for approximately 75% of all skin cancers in the United States; risk factors include fair skin and history of heavy sun exposure. Alternate presentations include: Chronic ulcer that bleeds, oozes, or crusts Reddish patch or irritated area (superficial BCC) Pearly or translucent nodule that is pink, red, white, or skin toned (nodular BCC) Pale, scarlike area with poorly defined borders BCC only rarely metastasizes but can invade nearby tissues (eg, nerves, bone). Nodular BCC on the trunk or extremities is typically managed with standard surgical excision with 3- to 5-mm (narrow) margins. However, for the face and other delicate or cosmetically sensitive areas, Mohs micrographic surgery (sequential removal of thin skin layers with microscopic inspection to confirm that the margins are clear of malignant tissue) is more often performed. Mohs micrographic surgery (Choice B) Keratoacanthoma is a rapidly growing, volcano-like nodule with a central keratotic plug. Although these lesions may regress spontaneously, many are excised, especially if the lesion is near an important structure (eg, eye). Keratoacanthoma (Choice C) Pyoderma gangrenosum presents as a painful, rapidly expanding ulcer with purple/dusky margins. It typically occurs on the trunk or a lower extremity, most commonly in patients with systemic disease (eg, rheumatoid arthritis, inflammatory bowel disease). ulcer (Choice D) Pyogenic granuloma is a vascular tumor that presents as a red, beefy, friable nodule that grows rapidly over weeks or months. The lesions can bleed with minor trauma but are not typically ulcerated. nodule (Choice E) Squamous cell carcinoma is much less common and grows faster than BCC. It often arises from a precursor lesion, such as an actinic keratosis, and typically has overlying hyperkeratosis. Squamous cell carcinoma actinic keratosis Educational objective: Basal cell carcinoma is the most common skin malignancy in the United States. It typically presents as a slow-growing nodule with pearly, rolled borders. Although it only rarely metastasizes, it may invade local tissues and should be removed. References: Basal cell carcinoma. (http://www.ncbi.nlm.nih.gov/pubmed/24720082)

A 48-Year-Old Woman Comes to the Office Due to a Lesion