A 60-year-old woman with a past history of many non-melanoma skin cancers presented for a total body skin check. A tender nodule was discovered on the left wrist.
Key point: A solitary 4 by 4-mm, tender, freely mobile, firm-feeling nodule was present on the volar aspect of the left wrist. The differential diagnosis included hypertrophic actinic keratosis, keratoacanthoma, squamous cell carcinoma, and verruca.
Treatment: The lesion was removed by deep shave excision, with electrodesiccation to the lesional base. Histology revealed hypertrophic actinic keratosis.
Note: The potential for the lesion being a squamous cell carcinoma dictated removal with histologic examination.