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A 73-year-old Scandinavian male was undergoing a routine physical examination when his physician noted a roundish spot about 6 mm (1/4 inch) in diameter that was slightly pinker than the remainder of the man's face. When he ran his finger across it he also noted that was dry and rough. The patient informed him that something had been going on with that spot for a year or so; its appearance seemed to wax and wane essentially disappearing once in a while but then returning, sometimes covered with white scales that then dropped off. When asked, the patient admitted that as a boy and a young man he spent countless hours at the beach body surfing and never used sunscreen. The physician cauterized the lesion with liquid nitrogen. Within 2 weeks the area became crusted, shrank and fell off. Two weeks thereafter the rough spot returned, and after a month, the patient developed an open sore at the same location that would not heal. The sore is most likely to be which one of the following?
A: Actinic keratosis
B: Basal cell carcinoma
C: Squamous cell carcinoma
D: Nodular melanoma
E: Herpes infection
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C...
he had actinic which has now become an SCC
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i think C since melanoma will be dark in colour.
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The hallmark of a squamous cell carcinoma (choice C) is an open sore that won't heal. It is the second most prevalent form of skin cancer, with a yearly incidence in the United States of about 200,000 cases per year. Most occur in elderly subjects on areas exposed to the sun and are more prevalent in light-skinned individuals with an early history of time spent outdoors as a youth. Most of them are slow growing but if left untreated, will eventually penetrate the dermis and invade underlying tissue. A small fraction may become malignant. As a rule squamous cell carcinomas of the lip are most dangerous; these are most commonly found among habitual pipe smokers.
Actinic keratosis (choice A) is a reddening and roughening of the skin found in sun-exposed areas, most commonly in light-skinned elders. It may present as a single spot as in the case described or it may be spread over a wider area, giving the affected person a blotchy appearance. Some 15% will transform into a cancer, almost always a squamous cell carcinoma as in the case described. A basal cell carcinoma (choice B) is the most common of all the skin cancers. It has been estimated that some 800,000 Americans are affected at any given time. It too appears to be sun induced and is most commonly found on the exposed areas of skin in lightly pigmented persons. They have several modes of presentation, the most common one being a shiny, pearly translucent nodule. Basal cells carcinomas arise from the basal cells of the epidermis and almost never metastasize. A nodular melanoma (choice D) is the most aggressive of all the melanomas. It generally is first recognized as a pigmented, usually dark brown or black, bump or node. Unlike most melanomas, it does not initially spread superficially but rapidly grows into deeper tissues, infiltrating the subcutaneous lymphatics and metastasizing to the nodes. The prognosis is understandably poor. Contrary to common opinion, nodular and other melanomas (with the exception of lentigo melanoma) are not usually induced by exposure to the sun, and most melanomas are more commonly found on the trunk or limbs than on the face or other exposed areas. A herpes infection (choice E) may exist as an open sore but rarely as an isolated lesion and is never preceded by a rough, pinkish lesion.
