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.
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NUMBER 9
MARCH 2018 • 199