A 73-year-old woman is urgently referred to dermatology for evaluation of a facial lesion. It is unclear how long the lesion has been present, but it has caused great alarm to the patient's visiting relatives. The patient herself is not at all worried, saying that she doubts “a little thing like that could cause too much trouble.”
She denies any symptoms associated with the lesion and claims to be in good health. There is no history of weight loss, cough, or changes in mentation or gastrointestinal/genitourinary function. She admits to some sun exposure as a young adult but claims she has never been sunburned; she reports tanning easily and holding a tan well.
EXAMINATION
The lesion is a 1.4-cm round epidermal plaque with a rough, warty surface. It is located in the left lower medial epicanthal area, verging on the upper nasal sidewall. Its dark brown color is uniform, as is its surface texture. It appears in the context of the patient’s relatively dark type III skin, which is largely free of signs of sun damage.
PROCEDURE
After potential treatments are discussed with the patient, she opts to have cryosurgery. During the procedure, it is noted that the lesion remained white for several seconds after it was frozen.
Two months later, the site is rechecked. The lesion is virtually gone, except for a faint shadow of hyperpigmentation in the treated area.
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