Growth on right hand
A 56-year-old man presented to his family physician (FP) with a growth on his right hand that had been there for the past year. The patient thought the growth could be a wart, so he started applying over-the-counter salicylic acid to the area 1 month prior. He indicated that he’d had warts on his fingers when he was a child, but this was the first lesion he’d had as an adult. Aside from controlled hypertension, the patient had no other known medical problems. He also mentioned that he worked outdoors as a landscaper.
What’s your diagnosis?
The FP recognized that this could be a wart but was concerned that it might be a squamous cell carcinoma (SCC) related to HPV and sun exposure.
He performed a shave biopsy and the pathology report indicated it was an SCC in situ. (See the Watch & Learn video on “Shave biopsy.”) At the follow-up visit, the FP reviewed the patient’s treatment options, which included topical 5% fluorouracil, topical imiquimod, and surgical excision. He also explained that the topical treatments were off label, so these options might have a lower success rate than the surgery.
,The patient chose to have the surgery, even though he’d be out of work while the excision site was healing. The FP provided counseling about sun avoidance, the consistent use of a hat outdoors, and the use of sunscreens when exposed to the sun. He also referred the patient to a dermatologist who had extensive experience doing skin cancer surgery.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Karnes J, Usatine R. Squamous cell carcinoma. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:999-1007.
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