Photo Rounds

Scaling lesions on arm

A 67-year-old man presented to his family physician (FP) with 2 scaling lesions on his left arm. He said they’d been there for the past 6 months and weren’t bothersome. Two years earlier, he’d had a basal cell carcinoma on his right arm surgically excised. The patient had worked outdoors for many years and was worried that he had another skin cancer.

What’s your diagnosis?


Scaling lesions on arm

The FP also was concerned about a possible skin cancer, especially for the larger of the 2 lesions. The FP recommended 2 shave biopsies, which the patient agreed to. (See the Watch & Learn video on “Shave biopsy.”) The patient was directed to apply petrolatum once or twice daily to the biopsy sites and to cover them with dressings for the next 1 to 2 weeks. On the 2-week follow-up, the physician diagnosed the larger lesion as squamous cell carcinoma in situ (Bowen disease) and the top lesion as actinic keratosis.

The physician explained that the actinic keratosis did not need further treatment; however, the options for treating Bowen disease included cryosurgery, electrodesiccation and curettage, or elliptical excision. The patient chose an elliptical excision, which was performed without complications at the following visit.

The margins were clear and the surgery site healed without any problems. The patient said that he planned to wear long sleeves more often and use sunscreen when his arms were exposed to the sun.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R, Wah Y. Actinic keratosis and Bowen disease. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:969-976.

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