Academic Question?

A 43-year-old man with no significant medical history presents to his primary care provider (PCP) complaining of a %26quot;wound that won閳ユ獩 get better%26quot; on the left side of his neck. He states that the wound has been slowly growing over the past 2 years after it first appeared as a small pimple. In his efforts to heal the wound, he has used a variety of over-the-counter topical remedies such as hydrogen peroxide and triple antibiotic ointment; however, the wound has continued to spread and worsen. He was finally encouraged to visit his PCP when his brother noticed the now several-centimeters-long lesion (see Images 1-2). The patient denies having weight loss, fevers, or chills. He has not traveled during the past 5 years.

On physical examination, the patient is somewhat overweight. His vital signs are normal except for a blood pressure of 165/93 mm Hg. The examination of the head, eyes, ears, and nose is unremarkable. The patient has a 10-cm ulcer at the collar line on the left side of his neck. A homemade dressing that the patient had placed on this lesion contains a small amount of serosanguineous fluid. No lymphadenopathy and no masses are noted around the neck or in the armpits. The patient閳ユ獨 lungs are clear, and his heart rate is regular with normal heart sounds. The rest of the physical examination findings are unremarkable, except for numerous small hyperpigmented macules on the patient閳ユ獨 chest and back.

What is the most likely diagnosis, and what is the diagnostic test of choice?

Academic Question?

The only sure way to tell is with a biopsy. But just based on the information provided I would think it to be advanced basal cell carcinoma of the neck. It%26#039;s skin cancer that fortunate for him is localized and slow growing. It%26#039;s common and doesn%26#039;t generally spread though if untreated can grow into surrounding tissue.

Basal Cell Carcinoma

http://en.wikipedia.org/wiki/Basal_cell_...

Medline Plus: Basal Cell Carcinoma

http://www.nlm.nih.gov/medlineplus/ency/...

Academic Question?

Thank You For Answering My Question.

Her BP was 173/37 but had been going down slowly Report It

Academic Question?

May be he has got tuberculosis of the skin or of the ganglion (lymph nodes) with complicates. So, needing a biopsy lesion

- an other diagnostic may be necro -dermatitis, needing culture bacteria the fluid from the lesion

Academic Question?

Squamous cell or basal cell skin cancer.I would biopsy.

Academic Question?

Most likely CA either basal cell carcinoma or melanoma. No choice but to biopsy preferably by dermatology or oncology. But what do I know? I am not a Doctor God like you. I am simply a nurse.