Evaluation of Skin Lesions in a 53-Year-Old Female

By: Dr. Ashley Baldree

At Village Dermatology, we prioritize comprehensive skin evaluations, especially for patients with a personal or family history of skin abnormalities. This case highlights the importance of regular skin checks and timely biopsies in the early detection and management of potentially harmful lesions.

Patient Background

A 53-year-old established female patient presented to our clinic for evaluation of brown, moderate skin lesions. These lesions were located on the left hand, left forearm, and right zygoma. Her medical history was notable for dysplastic nevi, a condition that requires vigilant monitoring due to an increased risk of skin cancer.

Clinical Findings

On physical examination, the patient appeared well-nourished and in no acute distress. The evaluation, which included dermatoscopic inspection of the head, face, left forearm, and hand, identified multiple pigmented lesions.

1. Benign Nevi
   These pigmented nests of cells were observed across various body sites without any signs of malignancy. No immediate intervention was necessary.

2. Papule on the Left Dorsal Middle Finger
   A suspicious papule raised concern for a neoplasm of unspecified behavior. Differential diagnoses included cyst, dermatofibroma (DF), or blue nevus.

   • Procedure: A shave biopsy was performed under local anesthesia and sent for histopathological examination.

3. Papule on the Left Ventral Proximal Forearm
   Another suspicious lesion was identified on the inner forearm. Differential considerations included congenital nevus or melanoma.

   • Procedure: A shave biopsy was also completed on this site under sterile conditions.

Dermatologic Interventions

Each biopsy was done using a Dermablade after administering lidocaine with epinephrine. Drysol was applied for hemostasis, and post-procedural care included Petrolatum and bandaging. The patient was thoroughly counseled on signs of complications and instructed to contact the clinic if results were not communicated within two weeks.

Patient Counseling & Prevention

• Monthly Self-Skin Exams were emphasized to help the patient monitor for changes in size, color, or shape of moles.

• Sun Protection: Use of a broad-spectrum SPF 30+ sunscreen was recommended daily.

• Skin Cancer Awareness: Education was provided on warning signs such as itching, bleeding, or rapid growth of lesions.

The patient plans to return in six months for a full-body skin screening, reinforcing the value of ongoing dermatologic surveillance.