Photo Rounds

Pink shoulder lesion

A 60-year-old man with a history of actinic keratosis presented to Dermatology for a skin exam. The physician noted an asymptomatic 8-mm pink papule on the patient's left scapula.

What’s your diagnosis?



Pink shoulder lesion

A scoop shave biopsy was performed and histology was consistent with a nodular basal cell carcinoma. BCC is the most common skin cancer in the United States, occurring in approximately 30% of patients with skin types I and II.1 In patients who are Black, squamous cell carcinoma is more common than BCC.2 The overall incidence of BCC is increasing by 4% to 8% every year in the United States.1

BCC most often affects sun-damaged areas—especially on the head and neck—and frequently causes significant tissue damage. It is, however, associated with a low risk of metastasis and mortality.

BCCs may appear as a pink, brown, blue, or white papule or macule. The surface is frequently shiny or pearly in appearance with a rolled border. Dilated, angulated, tree-branch like vessels termed “arborizing vessels” are common. Infiltrative BCC subtypes may look like melted candlewax and extend beyond the area that is clinically apparent.

Partial shave biopsies of a lesion can confirm the diagnosis. A punch biopsy can make it easier to evaluate flat (or even sunken) lesions.

The patient described here was treated with electrodessication and curettage (EDC)—a fast, economical, and effective treatment for the low-risk subtypes of superficial or nodular BCCs on the trunk or extremities. EDC should be avoided with higher risk subtypes of micronodular and infiltrative BCC. With these subtypes, excision (with 4- to 6-mm margins) or Mohs microsurgery is recommended.

Photos and text for Photo Rounds Friday courtesy of Jonathan Karnes, MD (copyright retained). Dr. Karnes is the medical director of MDFMR Dermatology Services, Augusta, ME. References

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