A 65-year-old farmer has an indolent, pale, raised, waxy, 1.2-cm skin mass over the bridge of the nose. The mass has been slowly growing over the past 3 years. There are no enlarged lymph nodes in the neck. Other than a "weather-beaten" appearance for the rest of his exposed skin, the remainder of the physical examination is unremarkable. Which of the following is the most likely diagnosis?
|A||Basal cell carcinoma|
|B|| Invasive melanoma|
|D|| Pyogenic granuloma
A. Basal cell is the most common type of skin cancer and is subdivided into several types by gross and histologic morphology.
a. The nodulocystic or noduloulcerative type accounts for 70% of basal cell carcinomas..
b. Basal cell carcinomas usually are slow growing, and patients often neglect these lesions for years. Metastasis and death from this disease are extremely rare, but these lesions can cause extensive local destruction. They are also called "rodent ulcers
B. Pyoderma gangrenosum (PG)
a. A rapidly enlarging, necrotic lesion with an undermined border and surrounding erythema characterize this disease.
b. Associated with an underlying systemic disease in 50% of cases.
c. Common underlying disorders include inflammatory bowel disease, rheumatoid arthritis, hematologic malignancy, and monoclonal immunoglobulin A (IgA. gammopathy.
d. The majority of patients are treated with systemic steroids and cyclosporine.