Can You Identify This Asymptomatic Lesion on an Elderly Man’s Temple?
An 81-year-old white man presented with a pigmented lesion in the right temple area. The patient reported that he had first noted the lesion approximately 7 years ago and that it had very slowly increased in size with time. The lesion was asymptomatic. The patient was otherwise in good health. He had worked in construction, and he enjoyed outdoor recreational activities. He had no family or personal history of skin cancer.
Physical examination revealed a flat, dark brown patch with irregular borders, asymmetric shape, and color variegation in the right temple area. Lesions of seborrheic keratosis were present in the adjacent areas and on other parts of the face. The rest of the physical examination findings were unremarkable.
Dermoscopy revealed asymmetric pigmented follicular openings, homogeneous areas with obliteration of follicular openings, gray dots and globules, and rhomboidal structures. Histologic examination of a biopsy specimen showed increased numbers of atypical melanocytes along the dermal-epidermal junction and effacement of rete ridges.
What’s Your Diagnosis?
a. Lentigo maligna
c. Seborrheic keratosis
d. Pigmented basal cell carcinoma
e. Melanocytic nevus
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