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step2ck_form8/Block 3/Question#34 (3.8 difficulty score)
A 67-year-old man comes to the physician 2 ...
Excisional biopsy with narrow marginπŸ”

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submitted by step_prep2(18),
  • Elderly patient with significant sun exposure (landscaper, farmer, etc.) with an ulcerated, shiny lesion on their chest most consistent with a squamous cell carcinoma or basal cell carcinoma
  • Key idea: Concerning skin lesions should be fully excised with ~3 mm margins unless the lesion is very large or in a location where complete excision may be problematic (ear, face, etc.)

submitted by keyseph(43),

An ulcerated base and a shiny, slightly raised border suggests BCC instead of SCC. Management of BCC is excisional biopsy with narrow margin (3-5 mm). If the lesion were SCC, management would be excisional biopsy with wide margin (5-10 mm).