A 47-year-old man notes the recent onset of an asymptomatic lesion located on the upper arm. He has been employed as a construction worker in Houston for several decades and denies the use of sunscreen.
Key point: The smooth and translucent nature of this nodule suggests the correct diagnosis: basal cell carcinoma. There is some heavy pigmentation to the lesion which might, justifiably, suggest a diagnosis of melanoma.
Treatment: The lesion was excised with a 5 mm margin of normal skin. Histologic analysis of the specimen confirmed clear peripheral and deep margins.
Note: Basal cell carcinoma can be variably pigmented, especially when the patient’s skin tone is dark. This patient was Hispanic. When there is doubt about the diagnosis, a small biopsy would be in order to make sure the proper excisional margins are being observed. Before the definitive excision, a 2-mm punch biopsy was performed to exclude the diagnosis of melanoma.