How would you treat this erythematous, scaly patch?

During a general skin examination, a lesion is noted on the chest of a 44-year-old man. The patient was completely unaware of this erythematous, scaly patch and is unable to provide any history.

Your course of action is to:

A. Wait and watch for the next 3 month.

B. Perform a potassium hydroxide examination.

C. Perform a skin biopsy.

D. Prescribe a topical corticosteroid.

E. Try a topical antibiotic for suspected impetigo.

(Answer on next page)

Answer: Basal cell carcinoma

The friable, asymptomatic lesion raised suspicion of cutaneous malignancy. A skin biopsy, C, confirmed the clinical impression of basal cell carcinoma.

Impetigo and ringworm are usually more symptomatic than the lesion seen here. Application of a topical corticosteroid would temporarily improve the appearance . . . and delay the diagnosis.