The FP suspected skin cancer, but was not sure if it was a basal cell carcinoma or a squamous cell carcinoma (SCC).
The growth was somewhat pearly with telangiectasias, but there was also a prominent area of keratin on the posterior aspect of the lesion. After injecting local anesthesia with 1% lidocaine and epinephrine, the physician performed a shave biopsy on one edge of the tumor. He was careful to avoid cutting the cartilage and decided that the diagnosis would be obtained without trying to remove the whole tumor. The bleeding did not stop with chemical hemostasis alone, so electrosurgery was used. The biopsy result showed an SCC of the keratoacanthoma type.
The patient was referred for Mohs surgery because it was important to get clear margins, while attempting to preserve the ear anatomy. Also, SCC of the ear has a higher risk for metastasis, so a thorough exam of the head and neck for lymphadenopathy was performed. Fortunately, this SCC was well-differentiated and no metastases were clinically detected.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Guzman A, Usatine R. Keratocanthoma. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:977-980.
To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/.
You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com.