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September 2002
Case submitted by Stephen M. Schleicher,
MD, and Lawrence A. Schiffman, DO
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CASE:
A 52-year-old man requests treatment for a contact dermatitis
of the hands. The clinician notes that this patient also has
an asymptomatic, erythematous, well-demarcated patch on his
upper back measuring more than 4 cm in diameter and a similar,
smaller patch on his lower back. His wife believes that both
patches have been present for at least two years. The patient
is a longtime cigarette smoker with a history of moderate
sun exposure. Medical and family histories are negative for
skin cancer.
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| What is your diagnosis? |
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The lesions on the patient's back are basal
cell carcinomas (BCC). This is the most common type of skin
cancer, with hundreds of thousands of new cases diagnosed each
year. The neoplasm is locally invasive but metastatic spread
is extraordinarily rare. Fair-skinned individuals with a history
of heavy sun exposure and anyone with a family history of BCC
are at greatest risk. The so-called superficial BCCs, exemplified
by this case, are slowly enlarging, erythematous plaques that
may eventually develop pearly borders. The trunk is the most
common site of these lesions, which are usually multiple. Treatment
by curettage, full excision, liquid nitrogen, and radiation
all have demonstrated high cure rates. |
Dr. Schleicher is director of the DermDx Centers
for Dermatology of Northeastern Pennsylvania and a clinical instructor
of dermatology at Graduate Hospital's City Line Campus in Philadelphia,
Kings College in Wilkes-Barre, and Arcadia University in Glenside,
Pennsylvania. He is also a member of the Emergency Medicine editorial
board. Dr. Schiffman is a fellow at the DermDx Centers for Dermatology.
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