Suspicious Cheek Lesion Evaluated and Biopsied: A Case Study from Village Dermatology
Evaluating Persistent Facial Skin Lesions: Why Early Diagnosis Matters
Skin lesions that persist for months or years may seem harmless, especially when they are asymptomatic. However, certain growths on the face can represent early skin cancer or precancerous changes. At Village Dermatology, we emphasize the importance of professional skin evaluations to identify concerning lesions before they progress.
In this case, a patient presented with a longstanding facial lesion that required further investigation to rule out skin cancer.
Patient Presentation
A 65-year-old female presented as a new patient for evaluation of a skin lesion located on her right cheek. The lesion had been present for several years and months and remained asymptomatic throughout its course. The patient reported that nothing made the lesion better or worse, and she had not sought treatment previously.
Because facial lesions can represent a variety of benign and malignant conditions, a comprehensive dermatologic examination was performed.
Dermatologic Examination
A focused skin examination included the:
Face and head
Right upper extremity
Left upper extremity
Right forearm
Left forearm
A dermatoscope was utilized to closely evaluate the lesion and surrounding skin structures.
During examination, an erythematous nodule was identified on the right inferior central malar cheek. Given its appearance and location, further diagnostic evaluation was recommended.
Additional Findings: Excoriations on the Forearms
During the examination, the patient was also noted to have excoriations involving both forearms.
Excoriations are areas of skin damage caused by scratching or picking and can sometimes obscure the underlying cause of irritation.
The patient was advised to:
Avoid scratching affected areas
Apply a bland moisturizer twice daily
Use CeraVe® Anti-Itch Cream as needed
Apply triamcinolone acetonide 0.1% cream twice daily for up to two weeks per month
Education was provided regarding proper skin care and monitoring for new lesions.
Differential Diagnosis of the Facial Lesion
Based on the clinical examination, the lesion was classified as a Neoplasm of Uncertain Behavior (D48.5).
Possible diagnoses included:
Benign skin growth
Neoplasm of uncertain behavior
Basal cell carcinoma (BCC)
Basal cell carcinoma is the most common type of skin cancer and frequently develops on sun-exposed areas such as the face. Although BCC typically grows slowly, early diagnosis and treatment are important to prevent tissue destruction and cosmetic complications.
Because a definitive diagnosis could not be made through visual examination alone, a biopsy was recommended.
Why a Skin Biopsy Was Necessary
When a dermatologist encounters a lesion with suspicious characteristics, a biopsy is often the most reliable method for obtaining a diagnosis.
The patient was counseled regarding:
Observation versus biopsy
Surgical removal options
Potential risks and benefits of diagnostic testing
Risks discussed included:
Scarring
Infection
Bleeding
Scabbing
Incomplete removal
Nerve injury
Allergic reaction to anesthesia
After reviewing all options, the patient elected to proceed with a biopsy.
Procedure: Shave Biopsy of the Right Cheek
Written informed consent was obtained prior to the procedure.
The biopsy site on the right inferior central malar cheek was prepared with alcohol, and local anesthesia was achieved using approximately 0.5 cc of 1% lidocaine with epinephrine.
A shave biopsy extending to the level of the dermis was performed using a Dermablade. The tissue specimen was submitted for histopathologic examination (H&E staining) to determine the exact diagnosis.
Procedure Summary
Location: Right inferior central malar cheek
Lesion Type: Erythematous nodule
Differential Diagnosis: Neoplasm of Uncertain Behavior vs. Basal Cell Carcinoma
Biopsy Technique: Shave biopsy
Instrument: Dermablade
Anesthesia: 1% lidocaine with epinephrine
Hemostasis: Drysol
Dressing: Petrolatum and bandage applied
Pathology: Submitted for microscopic evaluation
The patient tolerated the procedure well and received post-procedure wound care instructions.
Understanding Basal Cell Carcinoma
Basal cell carcinoma is the most frequently diagnosed skin cancer in the United States. Risk factors include:
Chronic sun exposure
Fair skin
Increasing age
History of tanning bed use
Previous skin cancers
Common warning signs include:
Pearly bumps
Pink or red nodules
Non-healing sores
Lesions that bleed easily
Growths that slowly enlarge over time
Many patients mistake early skin cancers for harmless blemishes or scars, which is why regular skin examinations are so important.
The Importance of Early Detection
Facial lesions deserve particular attention because skin cancers on the face can grow into surrounding tissues and may require more extensive treatment if diagnosis is delayed.
A biopsy allows dermatologists to:
Confirm whether a lesion is cancerous
Identify the specific type of skin cancer
Determine appropriate treatment recommendations
Improve cosmetic and medical outcomes through early intervention
Skin Cancer Evaluations in Katy and Houston, Texas
At Village Dermatology, we provide comprehensive skin cancer screenings, diagnostic biopsies, and advanced treatment options for patients throughout Katy and Houston, Texas. If you have a persistent facial lesion, a growth that does not heal, or any concerning skin change, our experienced dermatology team can provide an accurate diagnosis and personalized treatment plan.
Early evaluation can make all the difference when it comes to protecting your skin health and achieving the best possible outcome.
