Dermatologic Look-Alikes Scaly Rough Patches

BRIANA FERNANDEZ; SHANGYI FU;TARA BRAUN, MD

A 67-year-old man presents to the office for a yearly skin check. The patient has a history of basal cell carcinoma, which was treated with Mohs surgery 2 years ago without incident. Because of his history of skin cancer, the patient is careful to routinely perform a skin check. He recently noticed several hard scaly spots on his forehead and scalp that he would like evaluated. He had similar lesions in the past that were treated at his last visit with liquid nitrogen without an issue. On physical examination, the patient has several papules with an erythematous base and white gritty scale of varying thickness scattered on the scalp, forehead, nose, forearms, and dorsal hands.

A 72-year-old woman presents to the dermatology clinic for a routine annual skin check. The patient has a fair complection and history of sun exposure during her youth. She has a history of numerous nonmelanoma skin cancers and actinic keratoses that she has monitored over the years. On her current visit, she points to a lesion on her left shin that has been present for approximately 3 months and is growing. The patient notes that the lesion is tender and sometimes bleeds. She does not have any similar lesions elsewhere on her body. On physical examination, a 1.2- x 1.3-cm pink scaly plaque with focal areas of ulceration is noted on the left anterior lower leg.