diagnosis

Mr. Fitzgerald is a 68-year-old male who used to work as a bricklayer for more than 30 years presented with an erythematous skin condition that has lasted about 3-4 years. He bikes to work 50 to 60 miles a week.

35x25mm Left forearm oval scaly erythematous patch with indistinct borders

Denies smoking

Decreased stream and dribbling of urine for the past four to five months

Long term sun exposure (brick layer for more than 30 years and biking for about 50-60 miles a week)

Used to drink alcohol

Slight right hip pain

Fair complexion

Painless patch

Splenectomy done about 15 years ago due to injury

Increasing age

Seizure disorder was diagnosed about 20 years ago. On carbamazepine.

No history of injury

No family history of skin cancers

Mr. Fitzgerald is a 68-year-old previously healthy male with a history of significant sun exposure who presents with a 35x25 mm erythematous oval patch on his left forearm that has been present for about 3-4 years and has been increasing progressively in size.

Left forearm lesion

35x25mm left forearm oval scaly erythematous patch with indistinct borders

Long term sun exposure (brick layer for more than 30 years and biking for about 50-60 miles a week)

Fair complexion

Left forearm lesion

35x25mm left forearm oval scaly erythematous patch with indistinct borders

Long term sun exposure (brick layer for more than 30 years and biking for about 50-60 miles a week)

Left forearm lesion

35x25mm left forearm oval scaly erythematous patch with indistinct borders

Long term sun exposure (brick layer for more than 30 years and biking for about 50-60 miles a week)

Incisional / punch biopsy

Risk for skin cancer is high due to the patient’s work history as a bricklayer and uses a bike to work (McCance & Huether, 2019)

Wide excision under local anesthesia in the office

Patch is in a relatively low risk in a cosmetically insignificant area. Wide excision can take out a wide margin of abnormal cells to ensure that only healthy tissue is left behind (McCance & Huether, 2019).

Mohs microscopic surgery

Referral might not be necessary because margins are clearly visible.

Education to avoid sun exposure and damage

Avoiding long exposure to the sun and wearing tightly woven cloths can prevent skin cancer (Dunphy et al., 2019). Wear SPF 15 or more sunscreen if staying out under the sun to protect the skin (Cash & Glass, 2021).

Educate patients on monthly skin examination

The importance of careful examination of the skin in certain patients cannot be overemphasized. This includes patients who have frequent sun exposure or have a history of skin cancer and other lesions. During these monthly skin examinations, the patients should report any changes in preexisting skin lesions or any new lesions.

Follow-up monthly for 3 months and then twice a year for 5 years and then yearly

If a diagnosis of Bowen’s disease is made follow-up is required. Follow-up should include complete physical examination of the skin to look out for any signs of new or changing skin lesions or recurrence at the primary site. This is because the patient diagnosed with any type of skin cancer has an increased risk of developing more skin lesions in the future or of recurrence of the primary lesion.

Referral to dermatologist or oncologist

Referral to a dermatologist or oncologist is necessary for all suspicious skin lesions, including nonmelanoma skin cancers. Most patients require only simple excision of the skin lesion, with follow up to monitor skin healing by the dermatologist or practitioner who performed the procedure.

Follow-up after 7 to 10 days