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By Lawrence A. Schiffman, DO, and Stephen
M. Schleicher, MD
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CASE:
A 66-year-old woman presents with an enlarging lesion of
her right axilla, which she believes to be a wart. She reports
that it bled recently, prompting her to seek medical attention.
The patient is a cigarette smoker with no history of skin
cancer. Examination of the affected area reveals a 3- x 5-cm
erythematous plaque with a hyperkeratotic, crusted core. Cervical
and axillary nodes are not palpable.
WHAT IS YOUR DIAGNOSIS?
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Cutaneous biopsy of this lesion revealed invasive squamous cell
carcinoma. This second most prevalent form of skin cancer is
rarely seen in sun-protected skin folds. Cigarette smoking is
a risk factor. If left untreated, up to 20% of cases may metastasize.
The uncommon location in this case illustrates the need for
total body skin examination. |
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Dr. Schiffman is a fellow at DermDx Centers
for Dermatology of Northeastern Pennsylvania, headquartered
in Hazelton. Dr. Schleicher is director of DermDx Centers
and a clinical instructor of dermatology at the Philadelphia
College of Osteopathic Medicine, at Kings College in Wilkes-Barre,
Pennsylvania, and at Arcadia University in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 37(6):37, 2005
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