Your clinical day begins with Mr. Frederick Michael. Fred has a slow-growing crusty lesion on his cheek under his right eye. He states it has been growing for a few months and hurts when he gently presses it. The lesion has not bled. It is a 9 mm irregular patch with yellow scale. On close examination, you see a pink border. When you press it, he complains of discomfort. Fred states that he has had some strange twitching in the area of the lesion. He does not associate it with the spot. The skin of your patient is a Fitzpatrick two and he has fair eyes. You know his eye color is associated with pheomelanin, and he has had extensive sun exposure with a history of multiple sunburns.
You take an extensive history and find that he has an immune suppressant for a kidney transplant. He is 85 years old and is a heavy smoker, and he drinks alcohol times 4 per night. You decide to perform a shave biopsy of the lesion and find squamous cell cancer. Due to his age (squamous cell cancer in patients over 80 causes more fatalities than melanoma), immune suppression (death from squamous cell skin cancer is high in immune suppressed patient) and other risk factors including alcohol and smoking; thus, you decide to refer the patient for Mohs surgery. You also let Fred know that twitching can be due to a squamous cell cancer of the skin.
The MOHS surgeon calls back and lets you know that the lesion was removed with one stage and was a Castle one. The provider tells you that you had wisely managed this patient. Another good day at work…right?
Join me in Atlanta this year. I will be presenting on dermatology. We will dive into rashes, skin cancers, benign skin disorders, connective tissue disease as well as a host of skin conditions. I love bringing my actual case studies accompanied by actual treatment and outcomes.
We can move dermatology cases from the most dreaded to the most exciting and fun cases on schedule.
Follow Kathleen Haycraft on social media at: