Evaluating Bleeding Chest Lesions in Older Adults | Biopsy for Neoplasm of Uncertain Behavior
By: Dr. Caroline Vaughn
Introduction
Skin lesions that bleed, ulcerate, or change over time warrant thorough evaluation—especially in patients with a history of skin cancer. At Village Dermatology, we regularly assess suspicious growths using advanced tools and precise biopsy techniques. This case describes a 77-year-old woman presenting with chronic, bleeding papules on her chest and a past history of squamous cell carcinoma (SCC).
Case Presentation: Longstanding, Bleeding Chest Lesion
Patient: 77-year-old female
Chief Complaint: Bleeding, irritated lesion on the chest
Duration: Several years
Past Medical History: Squamous cell carcinoma
Concern: Potential recurrence or malignant transformation
Physical Exam Findings
On examination, an erythematous papule was noted on the right lateral superior chest. The lesion was:
Moderately inflamed
Chronically present
Unresponsive to prior self-care
Given its bleeding nature and the patient’s SCC history, we considered the following differential diagnosis:
Neoplasm of Uncertain Behavior
Next Step: Shave Biopsy
To reach a definitive diagnosis, we performed a shave biopsy, which is a safe and minimally invasive technique for sampling superficial lesions.
🩺 Procedure Details:
Location: Right lateral superior chest
Technique: Shave biopsy to the dermis using a Dermablade
Anesthesia: 0.5 cc of 1% lidocaine with epinephrine
Hemostasis: Controlled with Drysol
Post-procedure Care: Petrolatum and dressing applied
The sample was sent to pathology for H&E staining to confirm diagnosis.
Patient Counseling & Safety Measures
We discussed:
Risks of biopsy: scarring, bleeding, infection, incomplete removal
Importance of follow-up for pathology results
When to call: If the lesion worsens or if results are not received within 2 weeks
Why This Matters in Katy & Houston, TX
As people age, the risk of skin cancer increases, particularly in sun-exposed areas like the chest and shoulders. This case underscores the need for early dermatologic evaluation—especially in patients with a cancer history or persistent, symptomatic lesions.
