Growth lateral to right eye
A 72-year-old woman presented to her family physician (FP) with a new growth lateral to her right eye. She noted that she’d felt a crusting in that area before, and that the funny looking growth had appeared a month earlier. Her medical history included basal cell carcinoma on her right arm 4 years prior to this visit; she denied any other skin cancers.
What’s your diagnosis?
The FP noted a horn-like growth on the patient's face with some scaling around it. He recommended a shave biopsy. His differential diagnosis included actinic keratosis and Bowen’s disease (also known as squamous cell carcinoma in situ).
A biopsy was performed with a DermaBlade using a shave technique deep enough to get the base of the horn and a good sampling of the abnormal-looking tissue. (See the Watch & Learn video on “Shave biopsy.”) The pathology report revealed a cutaneous horn in a squamous cell carcinoma in situ.
,The patient was referred to Dermatology for further treatment. Options included treatment with topical 5-fluorouracil (over weeks to months), standard excision, or Mohs surgery.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith M. Cutaneous horn. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:985-988.
To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/.
You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com.