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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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I recently had biopsies showing scalp( consisting of fairly uniform

Answered by
Dr.
Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 8806 Questions

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Posted on Sun, 10 Mar 2019 in Skin Hair and Nails
Question: I recently had biopsies showing scalp( consisting of fairly uniform squamous cells with eosinophilic cytoplasm and squamous eddies) and 2 cm lesion on chest(7x6x1 shave-acanthosis, papillomatosis,and squamous eddies. There is a lymphohistocyclic infiltrate within papillary dermis. Both impressions are seb keratosis. I have a history of SCC on the scalp the most recent was last August. The chest lesion was biopsied on the left third and I was hoping for biopsy that represented the entire lesion as it looks the most suspicious-raise bumps on pinkish background. The lesion doesn't look like the other SK -smaller and brown/tan. Would it make sense to biopsy other side of irregular area and if not how would you treat? If there was unbiopsied SCC would it be better to eave alone for future recognition or should we freeze? Thanks for all you do.
doctor
Answered by Dr. Kakkar S. 56 minutes later
Brief Answer:
Regarding a suspicious skin lesion

Detailed Answer:
Hello and welcome to ask a doctor service. I have reviewed your query and here is my advice.

A suspicious precancerous or cancerous lesion on chest should ideally be either biopsied from the most representative or suspicious part with a margin of normal skin or else excised entirely with a margin of normal skin. It should then be subjected to histopathology with special attention to the margins. If found to be cancerous then the area should be re-excised, if needed e.g if the margins are found to be involved. In your case, the decision to do a repeat biopsy rests with your treating doctor. If he thinks that there is suspicion about the remaining lesion then he should not hesitate and go ahead with the complete excision, rather than leaving it alone and later diagnosing it at an advanced stage of SCC. However, if he thinks that it is indeed Seborrheic keratosis, then the area can be either freezed or left as it is. A dermoscopy is a valuable clinical tool to distinguish between a similar looking Seborrheic keratosis and a Squamous cell carcinoma without the need for a biopsy.

Hope I have answered your query. Let me know if you need any more assistance.
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Kakkar S. 41 minutes later
Would it be difficult to excise a 2 cm lesion? Should I ask the Dr to use a dermascope??? She didn't originally. Are some doctors uncomfortable with dermascopy? It's been my experience that most dermatologists don't use them. Thanks!
doctor
Answered by Dr. Kakkar S. 10 hours later
Brief Answer:
Regarding a suspicious skin lesion

Detailed Answer:
Hi.

A 2 cm lesion with a margin of 5mm may require a flap of skin for closure. You can request for a complete excision specially if it concerns you since it looks different from other SKs.. Dermoscopy is a useful tool in those who use it. It is commonly use by Dermatologists specially those who deal with a lot of skin cancer, particularly melanoma, BCC, SCC.

take care
Let me know if you need any more assistance
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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