The Journal of the Arkansas Medical Society Issue 9 Vol 114 | Page 7

Special section where the JAMS will feature short dermatology cases. Derm Dilemma Blake St. Clair, MD Author Kevin St. Clair, MD Editor Mercy Clinic Fort Smith Communities Seek Interventional Cardiologists to work in Fort Smith, AR. T his approximately 4 cm slightly Answer: pruritic solitary plaque on the back B. The most likely diagnosis for this solitary, very slow growing, non-indurated, scaly and crusted plaque is superficial basal cell carcinoma. Skin bi- opsy is necessary to confirm the diagnosis and to differentiate it from another superficially invasive skin cancer that typically involves non-facial skin, squamous cell carcinoma in situ. Treatment op- tions for either of these indolent, unaggressive cu- taneous neoplasms include destruction by curet- tage and electrodesiccation, primary excision for small tumors, or less commonly topical therapy with imiquimod or five-fluorouracil or photody- namic therapy utilizing aminolevulinic acid. of a 57-year-old caucasian man has been slowly enlarging for the past few years. Over-the-counter 1% hydrocortisone cream has alleviated the itching to some degree, but the lesion has not resolved. What is the next most appropriate step in evaluation or treatment? A. Suggest over-the-counter topical terbinafine twice daily for two weeks, as this most likely represents tinea corporis B. Skin biopsy, as this lesion is suggestive of a superficial variant of skin cancer C. Prescribe a mid-potency topical corticosteroid twice daily for a maximum of 14 consecutive days, as this plaque is probably nummular dermatitis D. Prescribe topical calcipotriene twice daily for seven days, as psoriatic plaque is the most likely diagnosis E. Skin biopsy, as this lesion is most suggestive of extragenital lichen sclerosis et atrophicus (L,S, and A) Please send CV and cover letter to: Sarah Wilson Mercy Physician Recruiter Mercy Clinic Fort Smith 2901 S. 74th St. Fort Smith, AR 72903 Put your business or service in the hands of 4,500 Arkansas physicians. Tinea corporis may present as a slowly, cen- trifugally enlarging solitary patch, but generally has an elevated, scaly border, central clearing, and dermatophyte hyphae visible upon micro- scopic examination of scrapings prepared with potassium hydroxide. Neither nummular dermatitis nor psoriasis would be expected to manifest as solitary trun- cal plaques for years. Extragenital L,S, and A can be solitary, but manifests most frequently as a painful, white, atrophic, shiny-surfaced plaque of prepubertal girls, postmenopausal women, and males between the second and sixth decade of life. For more advertising information, contact Penny Henderson at 501.224.8967 or [email protected] NUMBER 9 MARCH 2018 • 199