A 72-year-old man who is a retired construction worker comes to the physician because he has had a lesion on his face for 3 months. Physical examination shows a 6-mm, red, ulcerated lesion with heaped borders. A biopsy specimen of the lesion shows atypical, dysplastic keratinocytes within the epidermis and dermis. Which of the following is the most likely diagnosis?
Actinic keratoses
Discoid lupus erythematosus
Melanoma
Mycosis fungoides
Squamous cell carcinoma
Correct answer
Squamous cell carcinoma
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correct answer: E
Skin cancer comes in three major forms - squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and melanoma. This patient’s presentation and histology suggest squamous cell carcinoma. In general, a lesion described as ulcerated or with heaped borders is cancerous until proven otherwise. The atypical and dysplastic keratinocytes indicate a squamous cell origin.
Actinic keratosis is a thick, scaly lesion that a predecessor lesion to SCC. It would be fair to consider in this patient except that the clinical presentation describes a lesion that has progressed much further.
Melanoma is a neoplasm of melanocytes. Melanoma should be associated with ABCDE - Asymmetry, irregular Borders, multiple Colors, Diameter greater than 5mm, and Evolution of a pre-existing nevus. Melanoma is more common in younger people.
Mycosis fungoides is a presenation of cutaneous T-cell lymphoma; this patient’s histology is not suggestive of such a rare diagnosis.