++
Since dermatology is a visual science, take a look at pictures at www.dermnet.org.nz/sitemap.html, or www.dermnet.com. See Table 17-1 for commonly used dermatology terms.
++
++
A 37-year-old white female presents to clinic for her annual well adult physical examination. After a complete skin examination, you find a suspicious lesion on her back (Fig. 17-1). It measures 16 mm × 8 mm. She has approximately 20 nevi that appear normal. The patient reports never performing self-skin examinations and does not know if the lesion in question is new. She denies any symptomatic lesions. Her family history is remarkable for "skin cancer" on her father's side. Many family members have "tons of moles." She frequented a tanning parlor in college (too much free time … probably majored in communications) and occasionally still does so before social events (didn't learn much about skin health in college).
++
++
++
++
++
++
++
Question 17.1.1 How do you evaluate the lesion?
++
++
++
A) Take a photograph and see her back in 2 months
++
++
B) Take a shallow shave biopsy of the lesion
++
++
C) Excise the entire lesion with 1- to 2-mm margins
++
++
D) Excise the entire lesion with 3-cm margins
++
++
E) All of the above are equally valid approaches
+
++
Answer 17.1.1 The correct answer is "C." This lesion is worrisome for malignant melanoma because of the different pigmentation colors and irregular borders. Any time you suspect melanoma, you are obligated to completely remove the entire lesion ...