Photo Quiz

Changing Facial Lesion

 


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Am Fam Physician. 2015 Nov 15;92(10):925-926.

A 70-year-old black woman presented with an enlarging lesion on the left side of her face. The lesion had been present as long as the patient could remember, likely since birth. It had slowly enlarged as she aged. Recently the lesion had begun to change in appearance, and the patient developed new associated pruritus, pain, and bleeding.

The physical examination revealed a 6-cm × 1-cm linear verrucous lesion extending from the anterior helix of the left ear down to the level of the ear lobe (Figure 1). The lesion was hyperpigmented and raised, and consisted of papules and nodules. There was an area of excoriation near the distal end of the lesion where one of the nodules had torn away from the base.


Figure 1.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Keratoacanthoma.

B. Nodular basal cell carcinoma.

C. Sebaceous nevus.

D. Squamous cell carcinoma.

Address correspondence to Gregg Mitchell, MD, at gmitche2@uthsc.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Nevus sebaceous. In: Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 4th ed. Edinburgh, Scotland: Mosby; 2004....

2. Moody MN, Landau JM, Goldberg LH. Nevus sebaceous revisited. Pediatr Dermatol. 2012;29(1):15–23.

3. Wright TS. Nevus sebaceous and nevus sebaceous syndrome. UpToDate. January 30, 2014. http://www.uptodate.com/contents/nevus-sebaceous-and-nevus-sebaceous-syndrome (subscription required). Accessed April 22, 2015.

4. Brewer JD. Keratoacanthoma: epidemiology, risk factors, and diagnosis. UpToDate. February 4, 2015. http://www.uptodate.com/contents/keratoacanthoma-epidemiology-risk-factors-and-diagnosis?source=search_result&search=Keratoacanthoma%3A+Epidemiology%2C+Risk+Factors%2C+and+Diagnosis&selectedTitle=1~35 (subscription required). Accessed April 22, 2015.

5. Wu P. Epidemiology and clinical features of basal cell carcinoma. UpToDate. May 4, 2015. http://www.uptodate.com/contents/epidemiology-and-clinical-features-of-basal-cell-carcinoma?source=search_result&search=Epidemiology+and+Clinical+Features+of+Basal+Cell+Carcinoma&selectedTitle=1~117 (subscription required). Accessed August 30, 2015.

6. Lim J, Asgari M. Clinical features and diagnosis of cutaneous squamous cell carcinoma (SCC). UpToDate. May 21, 2014. http://www.uptodate.com/contents/clinical-features-and-diagnosis-of-cutaneous-squamous-cell-carcinoma-scc (subscription required). Accessed April 22, 2015.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.

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