About 2 years ago, an itchy solitary lesion manifested on this 49-year-old man’s ankle; it has slowly grown in size and prominence. Although there is no associated pain or tenderness, he presents for evaluation because he is worried he may have skin cancer. This concern stems from a family history of “melanomas,” which further questioning reveals to more likely have been basal cell carcinomas (BCCs) or squamous cell carcinomas (SCCs). (This patient, like many, holds the misconception that all skin cancers are melanoma.)

The patient has spent a good deal of time in the sun over the years, but he tolerates it rather well, seldom burns, and is able to keep a tan for an extended period.

He denies picking at the lesion in question. But he does admit that he will “touch” or “rub” it many times a day.

Examination reveals a firm, roughly round, scaly epidermal nodule on the lateral aspect of the patient’s left lower leg. Its pigmentation matches the rest of his skin. There is little evidence of sun damage elsewhere on his body, and no other lesions.