Nodule on the Neck

Abstract

Eligible for 1 MOC SA Credit From the ABD This Photo Challenge in our print edition is eligible for 1 self-assessment credit for Maintenance of Certification from the American Board of Dermatology (ABD). After completing this activity, diplomates can visit the ABD website (http://www.abderm.org) to self-report the credits under the activity title "Cutis Photo Challenge." You may report the credit after each activity is completed or after accumulating multiple credits.An 80-year-old man presented to our clinic with a large lesion on the right upper neck of approximately 4 weeks' duration. He reported that it was rapidly increasing in size and had bled on several occasions. No treatments were attempted prior to the initial visit. He denied any constitutional symptoms. The patient had a history of nonmelanoma skin cancers but no other chronic medical problems. Physical examination revealed a large, 35×40-mm, erythematous nodule with central ulceration and overlying hyperkeratosis on the right upper neck. No palpable cervical, supraclavicular, or axillary lymphadenopathy was observed. An excisional biopsy of the lesion was obtained. WHAT'S YOUR DIAGNOSIS?a. atypical fibroxanthoma b. basal cell carcinoma c. keratoacanthoma/squamous cell carcinoma d. Merkel cell carcinoma e. primary cutaneous anaplastic large cell lymphoma