Skin & Subcutaneous Tissue


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M63_F1.jpg"}},{"insert":"\n\n"},{"insert":"Yet another day has begun - and yet again, you settle down in your comfortable seat at the dermatology clinic.\r\n\r\nYour nurse asks if the first patient should be shown in, to which you nod \u0022yes\u0022.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M63_F2.jpg"}},{"insert":"\n\n"},{"insert":"you are introduced to sixty-four-year-old Mr. Benson, who complains about a \u0022large mole\u0022 on the left side of his face.\r\n\r\n\u0022Honestly, doctor, I didn\u0027t really care - but my wife insisted that I show this. It\u0027s the internet, you know ...\u0022, he says.\n"}]}


{"ops":[{"insert":"You take a quick history.\r\n\r\nMr. Benson knows that the lesion is at least a year old - although he can\u0027t quite remember when he first noticed it. The lesion is painless and does not itch. He is completely asymptomatic otherwise.\r\n\r\nHis medical history is only significant for mild essential hypertension, first diagnosed 3 years ago, and well controlled on diet alone. He is not on any medications currently.\r\n\r\nMr. Benson has been a farmer for almost 44 years now (\u0022and still going strong!\u0022, he says proudly). Due to his occupation, he spends a lot of time under the sun, during all times of the year.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M63_F4.jpg"}},{"insert":"\n\n"},{"insert":"You ask Mr. Benson to sit on the examination table and take a look at the lesion.\r\n\r\nYou notice a slightly elevated lesion in the left zygomatic region, measuring ~12 mm in diameter. It is \u00a0reddish-brown in color, with an erythematous base. Palpation shows the lesion to be non-tender, with a sandpaper-like texture.\n"}]}


{"ops":[{"insert":"You proceed to evaluate the rest of the skin, and note several similar but smaller lesions over his bald scalp, on the extensor surfaces of both upper limbs, and on the back of both hands.\r\n\r\nThe remainder of the examination is unremarkable.\n"}]}


{"ops":[{"insert":"What will you do now?\n"}]}
1. Perform an excisional biopsy
2. Apply cryotherapy