dermatology

1. This elderly patient presented incidentally with the lesion below that had been slowly enlarging for several months. What is the single most likely diagnosis? A. Actinic keratosis
B. Amelanotic melanoma
C. Cystic basal cell carcinoma
D. Pyogenic granuloma
E. Squamous cell carcinoma

Answer: C

this is a cystic basal cell carcinoma. Variants on the classical 'rolled edge' in basal cell neoplasms are common. Variants include this one as well as superficial spreading variants—which can be mistaken for a patch of eczema. The site is an important clue however and this, bearing in mind the age of the patient, should be referred.