Itchy Lesion Leads to Delayed Diagnosis of Skin Cancer

Case Overview

This case involves an adult who underwent Mohs surgery for a skin spot on their forehead several years prior. They consulted a dermatologist for an itchy, scaly, white lesion in the same area. Initially diagnosed with seborrheic keratosis, they were advised to use dandruff shampoo. Over the following year, the lesion grew larger and became increasingly itchy. The individual reported these changes during a follow-up appointment and received the same diagnosis. After experiencing bleeding from the lesion, they contacted the dermatologist's office but were not seen until months later. Seeking a second opinion, a biopsy revealed basal cell carcinoma, leading to multiple excisions and grafting procedures. Expert review is sought to assess the standard of care provided in this situation.

Questions to the Dermatology expert and their responses

How often do you evaluate and manage patients who present with persistent itchy lesions that increase in size?

I routinely evaluate and manage patients with suspicious, itchy, bleeding, or changing lesions. Any lesions that are changing, growing, or bothering a patient should be closely evaluated for malignancy.

What pertinent protocols should be followed if a patient presents with a persistent itchy lesion that is increasing in size?

If they do not appear abnormal, they should still be followed up on in a reasonable amount of time to confirm there is no further growth or change.

About the expert

This expert has 10 years of experience in the field of dermatologic oncology. He earned his BS in physiology and neuroscience from the University of California, San Diego, and his MD from the University of California, Los Angeles. He completed a residency in dermatology and a fellowship in Mohs micrographic surgery and dermatologic oncology at Columbia University. Today, this expert is board certified in dermatology and micrographic dermatologic surgery. He stays active in his field as a member of various professional societies and is a named fellow of the American College of Mohs Surgery and the American Society of Dermatologic Surgery. He has published 18 peer-reviewed papers and serves as a reviewer for six renowned medical journals. Previously, he served as director of dermatologic surgery at Good Dermatology and as the medical director of dermatology and cutaneous oncology at Science 37, Inc. Currently, he serves as the director of cutaneous oncology, dermatologic surgery, dermatology, and the high-risk skin cancer clinic at a medical school in Washington, DC, where he also serves as an associate professor of dermatology and oncology.

E-028773

Specialties:

Dermatology