A 40-year-old man sought advice regarding therapeutic options for an asymptomatic, “red spot” on the flank. Review of systems was entirely negative. Family history was strongly positive for non-melanoma skin cancers.
Key point: There is no way to accurately diagnose this small, non-descript lesion by observation alone. A 2 mm punch biopsy revealed superficial basal cell carcinoma.
Treatment: Imiquimod 5% cream was applied at bedtime 5 days weekly for 6 weeks. The lesion cleared clinically by the end of this course.
Note: The differential includes both benign entities which can be ignored (eg, lichenoid keratoses) and malignancies that require more vigorous intervention (eg, squamous cell carcinoma in-situ.