NUR 643 Differentiate Between Skin Lesions Cancerous Versus Noncancerous

DQ1 Differentiate between the appearances of skin lesions in relation to cancerous versus noncancerous.

DQ2 A patient presents with abdominal discomfort to the point of being in the fetal position. What questions need to be asked of this patient? What examination techniques would you perform for this patient?

Despite the fact that benign skin lesions can undergo malignant transformation, the necessity and timing of the surgical resection have yet to be established. In this study, we analyse three cases of benign-appearing skin lesions, which were found to be carcinomatous on histologic examination and review the literature regarding the importance of prophylactic removal of benign-appearing skin lesion. The first and second cases were female patients wishing for cosmetic surgery. The first patient had a benign-appearing lesion on dorsum nasi, and the second patient had an inconspicuous lesion right along the right nasolabial fold. The third patient was a middle-aged male with a pigmented lesion on the left cheek, who presented to the clinic only after having met the operating surgeon through an acquaintance outside the hospital setting. All of the lesions were suspected to be of benign nature and were excised for cosmesis only. However, histologic examination of these lesions showed that the first two tumors were basal cell carcinoma with the last tumor being squamouse cell carcinoma. Thus, it is considered that removal of benign like skin lesion will result in good prognosis of patients scheduled to undergo other surgery.

Keywords: Skin neoplasms, Face, Nevus

In any given patient, the skin may contain various innate or acquired skin conditions. In general, most are common skin conditions with benign histology. However, the prevalence is high for skin lesions, with the majority of people having at least one type of pigmented skin disease. Despite the low rate of malignant transformation, the incidence of malignant skin tumors is high because the benign precursors are so highly prevalent. Because of this, skin cancers are known to be one of the most common carcinomas in the US [].

Malignant skin tumors are distinguished between non-melanoma skin cancer (NMSC) and malignant melanoma. Despite the fact that benign skin lesions can undergo malignant transformation, the necessity and timing of the surgical resection have yet to be established []. In this study, we analyse three cases of benign-appearing skin lesions, which were found to be carcinomatous on histologic examination and review the literature regarding the importance of prophylactic removal of benignappearing skin lesion.

CASE REPORTS

This study was conducted via chart review of 3 patients visiting aesthetic plastic surgery clinic between August 2013 and January 2014. All three patients had presented with clinical issue unrelated to skin lesions.

The first patient was a 68-year-old woman who presented with sagging of upper and lower eyelids as a chief complaint, and was scheduled to undergo blepharoplasty. During examination, a 1×1 cm tumor was observed on the dorsum nasi, which the patient reported to have first noticed 10 years before. Though the tumor appeared to be benign, the patient was offered resection as an aesthetic option at the time of blepharoplasty operation. The patient consented, and the tumor with 2 mm resection margin resection and blepharoplasty were performed simultaneously ().

The first is a 68-year-old female who had presented with aging periorbital soft tissue changes. The patient was offered and consented to the resection of the 1-cm mass on nasal dorsum, which had developed over a decade. (A, B) In the preoperative photograph, the mass is very obvious but benign-appearing. (C, D) Postoperative appearance at 6 months is satisfactory.

The second patient was a 59-year-old woman who presented with sagging of the upper eyelid and nasolabial folds, and was scheduled to undergo blepharoplasty of the upper eyelid and a filler injection. A 0.5×0.5 cm tumor was present on the right nasolabial fold, which the patient had first noted 15 years prior. The patient consented to and underwent resection of the lesion with 1mm resection margin for aesthetic purposes, along with blepharoplasty and filler injection ().