Question

At the insistence of his wife, a 71 year old farmer presents to have a "bump" on his shoulder evaluated. The bump has been there for several years, and though it is not painful, it does itch from time to time. The patient does report many years of sun exposure while working on his farm. Physical examination reveals a comfortable, fair-skinned gentleman. On the patient's left shoulder, there is a smooth, 3cm by 4cm papular lesion with numerous dilated blood vessels throughout. A photo of this lesion is seen here. Which of the following

is the most appropriate therapy for this patient?
A. Podophillin resin
B. Shave biopsy
C. Local excision
D. Topical tacrolimus
E. Excision, lymph node biopsy, and radiation

Answer 1

The most appropriate therapy for the described lesion on the farmer's shoulder, considering his significant sun exposure and the lesion's characteristics, is to perform a shave biopsy to confirm the diagnosis before proceeding with further treatment.

Step-by-step explanation:

The presentation of the lesion with its long-standing nature, smooth appearance, and dilated blood vessels, along with the history of significant sun exposure, raises suspicion for a type of skin cancer, possibly basal cell carcinoma which is common in sun-exposed areas. Given the size and characteristics of the lesion, the most appropriate next step in treatment is a shave biopsy. This procedure will confirm the diagnosis and help guide subsequent treatment, which may include local excision if the biopsy results confirm a malignant lesion. Therapy options such as Podophyllin resin, topical tacrolimus, and excision with lymph node biopsy and radiation are not the first-line treatments without a confirmed diagnosis and more information on the lesion. Therefore, shave biopsy is the most appropriate next step.