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By Christopher A. Snyder, DO, and Stephen
M. Schleicher, MD
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CASE:
A 70-year-old man presents for evaluation of an asymptomatic
scalp lesion that has been increasing in size over the past
six weeks. His medical history includes actinic keratoses
that have been treated cryosurgically with liquid nitrogen.
Examination of the mid-scalp reveals a 1.8-cm indurated plaque
with central scaling. Multiple keratoses are noted elsewhere
on his scalp as well as on his face. Cervical lymph nodes
are not palpable.
WHAT IS YOUR DIAGNOSIS?
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Atypical fibroxanthoma most commonly presents as a reddened,
dome-shaped nodule that arises rapidly on the head or neck of
an elderly individual. Most cases appear to be related to chronic
sun exposure or localized radiation therapy. Differential diagnosis
includes squamous cell carcinoma, malignant melanoma, and angiosarcoma.
Although the majority of lesions treated with simple curettage
or shave excision do not recur, spread to lymph nodes has been
reported, prompting some clinicians to recommend removal by
either full excision or Mohs micrographic surgery. |
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Dr. Snyder is an associate 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(8):27-28, 2005
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