Question

67-year-old white male presents with a freckle on the back of the neck that he has had for a long time but has grown during the past 6 months. What is the next best step?

A) Topical corticosteroids
B) Shave biopsy
C) Observation
D) Laser therapy

Answer 1

The next best step for the 67-year-old male with a growing freckle on his neck is a shave biopsy (Option B), to rule out or confirm a potential malignancy such as basal cell carcinoma.

Step-by-step explanation:

The next best step for a 67-year-old male who presents with a freckle on the back of the neck that has grown over the past 6 months is B) Shave biopsy. A growth on the skin that changes over time could potentially be malignant, and a shave biopsy is a procedure that would provide a definitive diagnosis by examining the tissue under a microscope. Early detection and treatment are crucial in skin conditions that may indicate skin cancer. While topical corticosteroids may be used for inflammatory dermatoses, and laser therapy for certain benign skin conditions, these are not appropriate first steps for a changing lesion. Observation would not be prudent given the change in size, and a shave biopsy can rule out or confirm malignancy, such as basal cell carcinoma, which is crucial for proper treatment planning. The Wood's lamp examination in other skin lesions like ringworm, illustrates a diagnostic tool but does not apply to a freckle that has changed in size over months, wherein biopsy is essential.