Question 9#

A 53-year-old woman presents to the clinic with an erythematous lesion on the dorsum of her right hand. The lesion has been present for the past 7 months and has not responded to topical corticosteroid treatment. She is concerned because the lesion occasionally bleeds and has grown in size during the past few months. On physical examination you notice an 11-mm erythematous plaque with a small central ulceration. The skin is indurated with mild crusting on the surface.

Which of the following describes this process? 

A) It is a malignant neoplasm of the keratinocytes with the potential to metastasize
B) This lesion is unrelated to actinic keratosis
C) It is a chronic inflammatory condition, which can be complicated by arthritis of small- and medium-sized joints
D) It is a malignant neoplasm of the melanocytes with the potential to metastasize
E) It is the most common skin cancer

Correct Answer is A


Cutaneous squamous cell carcinoma (SCC) is a malignant neoplasm of the keratinocytes; it can grow rapidly and may metastasize (1%-3% of cases). Actinic keratosis is considered a precancerous lesion. Clinically, SCC commonly presents as an ulcerated erythematous nodule or superficial erosion on the skin. SCC can occur anywhere on the body but is most common on areas of sun-damaged skin, including the lower lip. Nodular lesions should be excised. Psoriasis is a chronic inflammatory disease characterized by well-marginated erythematous papules and plaques covered by a silvery scale. A complication of this disease is asymmetric arthritis of the distal and proximal interphalangeal joints. Ulceration is not seen in psoriatic plaques. Melanomas are malignant neoplasms of the melanocytes that have the potential to metastasize. Metastasis and prognosis are related to depth of invasion. Melanomas, however, usually have areas of definite hyperpigmentation. Basal cell carcinoma (BCC) is the most common skin cancer, accounting for 70% to 80% of nonmelanoma skin cancers. It usually has a characteristic rolled or undermined border with telangiectasias around the lesion. Local invasion can be a serious problem, but BCCs almost never metastasize.