Actinic Keratosis in a 60-Year-Old Woman

September 5, 2013

The differential diagnostic possibilities for this tender nodule included hypertrophic actinic keratosis, keratoacanthoma, squamous cell carcinoma, and verruca. The possibility of squamous cell carcinoma dictated removal with histologic examination.

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.