History: This 75 yo woman was first seen on 12 October 2004 with a lesion on cheek. It had a crust and some purulent material. The lesion was surrounded by large seborrheic keratoses and I thought it was an inflammatory seb ker. Ulcer care with cleaning and Bactroban cream was recommended. I gave her a follow-up appointment and saw her back yesterday.
Physical Exam: There is a 4 cm flesh-colored plaque on the left cheek. The borders are somewhat rolled. There is a crust centrally which when removed shows an ulcer and creamy pus. (see photos)
Lab: Culture obtained. Grew out normal skin organisms
Path: 3 mm punch biopsy obtained. Jan 5, 2005 - Report indicates well-differentiated squamous cell carcinoma
Diagnosis: I suspect SCC or KA. I think the purulent drainage may relate to the squamous cells - I saw a similar case years ago on the back that I thought was a ruptured epidermal inclusion cyst. This lesion has changed in the past two months. It looked quite benign at her last visit.
Jan 5, 2005. I discussed results with patient and she will be referred for micrographic surgery. Exam today reveals a possible submandibular lymph node. I wonder if this is related to chronic inflammation in the tumor rather than mets.
Friday, December 31, 2004
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