Question

A 42-year-old fair-skinned woman of Irish origin presents with an abnormal skin growth that was first noted 7 years ago. On examination, a 2 X 3 cm lesion is noted over her left bicep. Which of the following historical elements most increases the suspicion that the lesion is malignant?
A) No evolution in size since onset, but mild intermittent pruritus over the last 2 years.
B) Proximal location, that is, over the bicep rather than the distal arm.
C) Minimal but discernible increase in size over the past 6 months.
D) No evolution in size since onset, but uniformly darkly pigmented color.
E) Presence of similar pinkish tan lesions on the sun‐exposed areas including the face and hands.

Answer 1

Answer:C) Minimal but discernible increase in size over the past 6 months.

Explanation:

Irrespective of the presence and length of a lesion, any discernible alteration in size or other characteristics (such as color or regularity of borders) requires further evaluation. Since its start, no change in size but moderate sporadic pruritus over the last 2 years is wrong. While any skin lesion may develop into malignancy, a long-standing, essentially unchanged lesion carries a very low probability of malignancy. Since the beginning no evolution in size but uniformly darkly pigmented color is wrong. Although dark lesions are sometimes of concern, lesions should be assessed specifically for color variation, in particular blue and black mixed with white and red(Which represents inflammatory processes and melanoma scarring characteristics). It is wrong to have identical pink tan lesions in the exposed areas of the skin, including the face and hands. In general, skin cancer is characterized by an initial focus of malignancy with distal metastases on organs other than the skin; multiple similar skin findings that do not meet the criteria in the mnemonic ABCDE‐EFG (Asymmetry, Border Irregularity, Color Variations, Diameter > 6 mm, Evolving, Elevated, Solid, Growing) are more likely to be benign. The proximal position is incorrect, that is to say, over the bicep rather than the distal limb. Proximal or distal location has no effect on the risk of malignancy.