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80-Year-Old Female with Asymptomatic Nodule on Back

Can you diagnose this case?

David L. Kaplan 2014 Series Editor @ University of Missouri – Kansas City School of Medicine

Signs and Symptoms

An 80-year-old female presented for evaluation of an asymptomatic nodule on her back of at least 3 months duration. She is otherwise healthy and denies any exposure history or new medications.

Your thoughts are to:

Choose one to reveal diagnosis and discussion

Prescribe trial of a topical corticosteroid cream initially for possible insect bite reaction
Order a skin biopsy for histological diagnosis
Prescribe an antibacterial antibiotic such as doxycycline for 3 weeks
Cryosurgery
“Wait and watch,” and re-evaluate in 3 months for any changes

Answer: Order a skin biopsy to decide subsequent course of action and treatment

See the full case at Consultant360

Suspicion of cutaneous B cell lymphoma led to a skin biopsy that revealed changes consistent with B-cell lymphoma using histomorphology and cytomorphology, immunohistochemistry and phenotypic features. Subsequent work-up was completely normal including bone marrow and PET scan. It was elected to conservatively watch the patient and lesion. She declined to have it excised as it was asymptomatic. Treatment options include local radiation, three week trials of doxycycline and intralesional steroids.