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February 2005
By Lawrence A. Schiffman, DO, and Stephen
M. Schleicher, MD
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CASE:
A 52-year-old man complains of a lesion on his right forearm
that has been growing for the past year. He is an avid fisherman
and admits to ample sun exposure. The lesion is asymptomatic.
The patient's medical history is significant for previous
basal cell carcinoma on the neck. On physical examination
a 1 cm x 2 cm erythematous, slightly indurated, circumscribed
patch is noted on the right forearm. Moderate actinic damage
of both arms is also observed.
WHAT IS YOUR DIAGNOSIS?
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A punch biopsy of this lesion revealed squamous cell carcinoma
in situ, also called Bowen's disease. This subtype of squamous
cell carcinoma may arise from a pre-existing actinic keratosis
and is most frequently found on the extremities. The lesion
slowly enlarges but metastatic spread is uncommon. Simple excision
is usually curative. Other therapeutic modalities include curettage,
liquid nitrogen cryosurgery, and topical application of fluorouracil. |
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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(2):33-34, 2005
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