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March 2004
By Stephen M. Schleicher, MD, and Lawrence
A. Schiffman, DO
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CASE:
A 47-year-old truck driver presents to your office as a referral
from a local family practitioner. The man had slipped on a
sheet of ice and broken one of his ribs. Upon examination
by his family physician, an incidental finding on the patient's
left flank was noted. It is a case that will certainly be
remembered.
WHAT IS YOUR DIAGNOSIS?
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Biopsy of this lesion revealed malignant melanoma. This case
classically depicts the ABCDs (asymmetry, border, color, diameter)
of suspected melanoma. The lesion is asymmetrical, with irregular,
scalloped borders. It varies in color from dark black to brown
to pink, along with areas of hypopigmentation, and is well over
6 mm in diameter. Exploration of the patient's history reveals
that the lesion has been present and slowly enlarging for about
a year and a half, and it occasionally bleeds. The man failed
to seek attention for it because he did not think it was anything
to worry about. Superficial spreading melanoma is the most common
type of melanoma. When neglected, vertical growth begins creating
a nodular component seen as the dark black elevation in the
center of the lesion. At that point, the prognosis is poor. |
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Dr. Schleicher is director of the DermDx
Centers for Dermatology of Northeastern Pennsylvania as well
as Schleicher Dermatology Associates in Bonita Springs, Florida.
He is a clinical instructor of dermatology at 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.
Dr. Schiffman is a fellow at the DermDx Centers and Schleicher
Dermatology Associates.
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