Case discussion: How would you treat this patient? [21 November]
This week we have a great case from Dr Kerry Lowe. A 49-year-old female presents with a lesion on her left forearm. It has been present for a couple of years but as she has kept catching it with her handbag it increased in size over the past few months, especially the “horn” component due to plenty of sun exposure. She has no family history of melanomas.
Lesion measured ~ 1 x 1 cm with idurated region at lesion base plus a 1 to 1.5 cm horn in its centre. What is your evaluation and what would you do next?
Case submitted by Dr Kerry Lowe
Performed 4mm punch biopsy over indurated region at a base of lesion (3 O clock position) and the patient had already knocked off most of the horn on the previous day. Having knocked it, shave biopsy was done after Punch biopsy. Both specimens were sent to pathology as outlined below:
The sections show a hyperkeratotic well differentiated squamoproliferative lesion. The pattern of keratinisation favours a keratoacanthoma; however, the deep aspect of the lesion is not present for assessment and therefore a squamous cell carcinoma cannot be excluded.
LEFT FOREARM, BIOPSY: WELL DIFFERENTIATED SQUAMOPROLIFERATIVE LESION, FAVOUR KERATOACANTHOMA.
What would you do next?
Please share your thoughts in the comment section below. Professor David Wilkinson will provide his opinion and advice.