Sun-Induced Skin Lesions

September 14, 2005
Robert P. Blereau, MD

n asymptomatic pink lesion measuring approximately 1 cm in diameter appeared on this 80-year-old woman's right cheek 3 weeks before this picture was taken.

An asymptomatic pink lesion measuring approximately 1 cm in diameter appeared on this 80-year-old woman's right cheek 3 weeks before this picture was taken (A). Robert P. Blereau, MD of Morgan City, La, excised the lesion with elliptical incisions. Microscopic evaluation confirmed the diagnosis of actinic keratosis showing atypia, underlying focal chronic inflammation, and basophilic degeneration of the dermal collagen. Other therapeutic options for actinic keratoses are cryotherapy and topical chemotherapy.

Basophilic degeneration of the dermal collagen can occur from chronic sun exposure, which causes premalignant actinic keratoses. An inflamed actinic keratosis apparently was the origin of the squamous cell carcinoma on the left ear helix of this 84-year-old man (B).

Dr Blereau writes that the lesion, with some superficial peeling above it, had been on the patient's ear for about 1 year. Coincidentally, he had an inclusion cyst at the tragus as well. The helix lesion was completely excised, and the diagnosis of squamous cell carcinoma with microfoci of early invasion was confirmed by microscopic examination.

A third patient sought Dr Blereau's advice for lesions provoked by sun damage. This 67-year-old man presented with a nodular ulcerated basal cell carcinoma at the bottom of his right lower eyelid (C). He also had an injected area believed to be an actinic keratosis below and lateral to the cancer (D). Recently, a squamous cell carcinoma was excised from the left side of his forehead, and another actinic keratosis at the top of his scalp was treated with 5-fluorouracil cream.

The basal cell carcinoma was excised with a generous margin of surrounding eyelid for completeness, and a mild postoperative right lower eyelid ectropion formed. This ectropion resolved spontaneously within 2 to 3 weeks.

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