A 32-year-old woman comes to the office due to a "mole." The lesion is located on her back, and she believes it has been present for years but does not recall when it first appeared. The patient thinks it might be enlarging and is concerned due to a family history of skin cancer. The lesion is not painful and does not itch or bleed. She has fair skin and a history of severe sunburns in childhood. Medical history is unremarkable, and she does not use tobacco, alcohol, or illicit drugs. Vital signs are normal. Skin examination shows a few scattered benign-appearing nevi and a single prominent lesion at her right scapular area. Which of the following additional skin examination findings would be most concerning for malignancy?

Question

A 32-year-old woman comes to the office due to a "mole."  The lesion is located on her back, and she believes it has been present for years but does not recall when it first appeared.  The patient thinks it might be enlarging and is concerned due to a family history of skin cancer.  The lesion is not painful and does not itch or bleed.  She has fair skin and a history of severe sunburns in childhood.  Medical history is unremarkable, and she does not use tobacco, alcohol, or illicit drugs.  Vital signs are normal.  Skin examination shows a few scattered benign-appearing nevi and a single prominent lesion at her right scapular area.  Which of the following additional skin examination findings would be most concerning for malignancy?

Quizplus · Accepted Answer

11ec25c8_d8b4_d82d_bc81_a71d675c1635_MD0003_00 Early diagnosis is critical in melanoma as survival rates rapidly decrease with increased tumor thickness and depth of invasion. Historical and examination findings are used in the evaluation of moles to determine which lesions require excision and which can be safely observed. Significant melanoma risk factors include prior personal or family (≥2 members) history of melanoma, numerous (>100) nevi, prior atypical/dysplastic nevi, fair skin, and history of severe sunburns. depth of invasion Gross features favoring the diagnosis of melanoma include Asymmetry, Border irregularities, Color variegation (ie, color differences within a single lesion), Diameter ≥6 mm, and change in appearance over time (Evolving lesion). Coloration of melanoma can be highly variable. Lesions can be pigmented or unpigmented and various shades of brown, black, red, blue, or pink. Color variegation in particular strongly suggests malignancy. Color variegation (Choice A) Keratoacanthomas are cutaneous tumors that usually present as dome-shaped nodules with a central keratinous plug. They are generally benign, although rare cases with malignant transformation and metastasis have been reported. Keratoacanthomas (Choice B) Lipomas present as slowly enlarging, mobile subcutaneous masses. They have a soft or rubbery texture and are often golf-ball size or larger by the time they are brought to clinical attention. Lesions with the typical appearance of a lipoma are rarely malignant and can be safely observed without biopsy. Lipomas (Choice D) Ring-shaped inflammatory skin lesions with peripheral scaling are characteristic of tinea corporis. tinea corporis (Choice E) Seborrheic keratosis is a benign pigmented lesion with a well-demarcated border and a velvety or greasy surface. It can be nearly flat, but thickened lesions are often described as having a "stuck on" appearance. An explosive onset of multiple seborrheic keratoses (Leser-Trélat sign) can indicate internal malignancy, but isolated lesions are benign. Seborrheic keratosis Educational objective: On clinical examination, features of a lesion that suggest melanoma include Asymmetry, Border irregularities, Color variegation, Diameter ≥6 mm, and Evolution in color, size, or shape. References: Skills training to learn discrimination of ABCDE criteria by those at risk of developing melanoma. (http://www.ncbi.nlm.nih.gov/pubmed/16618863)

A 32-Year-Old Woman Comes to the Office Due to a "Mole