A 53-year-old woman was told by her hairdresser to have a dermatologist look at the 1.3-cm diameter, painless nodule behind her left ear. The nodule had never bled. The patient was ostensibly in good health.
Key point: The nodule appears somewhat translucent, and coarse telangiectases are seen traversing the lesion’s surface. Despite the fact that this lesion is NOT in a sun-exposed skin site, the clinical features are typical for a basal cell carcinoma. This presumptive diagnosis was verified by biopsy. A solitary cutaneous metastasis from an internal malignancy was considered in the differential diagnosis.
Treatment: The neoplasm was removed by excision, and the defect closed by developing a flap.
Note: Non-melanoma cutaneous cancers may arise in relatively sun-protected sites.
A hematologically stable CML patient developed a solitary, exquisitely painful ulceration, 7 cm × 5 cm, located on the mid-medial foreleg. There was never any evidence of venous insufficiency. The patient denied the possibility of a spider bite. What is the likely cause of this lesion?
