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66-Year-Old Man with Sunexposed Arm Lesion

Can you diagnose this case?

David L. Kaplan – 2014 Series Editor University of Missouri: Kansas City, University of Kansas

Signs and Symptoms

A 66-year-old male presented with a small, asymmetrical, 2 mm blue nodule on the sun-exposed portion of his arm of a few months duration. There is no history of trauma and it does not blanch.

What would your approach to this lesion be?

Choose one to reveal diagnosis and discussion

Shave biopsy
A 3 mm punch biopsy
Wide excision with 5 mm margins
Wide excision with 1 cm margin
Follow conservatively and re-evaluate in 3 to 6 months

Answer: A 3 mm punch biopsy

See the full case at Consultant360 A 3 mm punch biopsy revealed the lesions to be a benign blue nevus. Blue nodules usually have some degree of dermal depth, which would make a shave biopsy a poor choice for a diagnostic procedure. While wide excisions would provide plenty of extra skin for examination, it would be premature to do a “definitive” procedure in the absence of a diagnosis. The conservative watching would not be recommended given the recent onset of presentation and given how easy and non-invasive a punch biopsy would be to the patient.