Whatever You Do, Don’t Touch It
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Joe R. Monroe, MPAS, PA, ­practices at Dermatology Associates of Oklahoma in Tulsa. He is also the founder of the Society of Dermatology Phyisican Assistants.

Worried about skin cancer, this 49-year-old man can’t stop touching the itchy, solitary, continually growing lesion on his ankle. Will your diagnosis expose it for what it is?

Question 1 of 1

Whatever You Do, Don’t Touch It

About 2 years ago, an itchy solitary lesion manifested on this 49-year-old man’s ankle; it has slowly grown in size and prominence. Although there is no associated pain or tenderness, he presents for evaluation because he is worried he may have skin cancer. This concern stems from a family history of “melanomas,” which further questioning reveals to more likely have been basal cell carcinomas (BCCs) or squamous cell carcinomas (SCCs). (This patient, like many, holds the misconception that all skin cancers are melanoma.)

The patient has spent a good deal of time in the sun over the years, but he tolerates it rather well, seldom burns, and is able to keep a tan for an extended period.

He denies picking at the lesion in question. But he does admit that he will “touch” or “rub” it many times a day.

Examination reveals a firm, roughly round, scaly epidermal nodule on the lateral aspect of the patient’s left lower leg. Its pigmentation matches the rest of his skin. There is little evidence of sun damage elsewhere on his body, and no other lesions.

The most likely diagnosis of this lesion is

Squamous cell carcinoma

Basal cell carcinoma


Prurigo nodularis

Clinician Reviews. 2019 March;29(3):3e

This quiz is not accredited for CME.

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