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Squamous Cell Carcinoma
Primary cutaneous squamous cell carcinoma: the appearance of this lesion alone suggests the proper diagnosis.
A 63-year-old woman with long-standing psoriasis and decades-long history of methotrexate ingestion presents with a solitary, hard, slightly tender nodule on the hand. A review of her past medical history also revealed extensive phototherapy. The patient was of Irish ancestry, with a very fair complexion, who sunburned easily.
Key point: The appearance of the skin lesion alone should strongly suggest the proper diagnosis: primary cutaneous squamous cell carcinoma.
Treatment: The lesion was excised under histologic control by Moh’s surgery. The resulting large defect was closed via split-thickness skin graft. Radiation therapy might be another treatment option.
Note: Although the patient learned early in life to avoid the sun, she was nonetheless exposed to therapeutic ultraviolet irradiation for many years, as well as to a known tumorigenic immunosuppressive (methotrexate). There is an element of iatrogenic etiology in this case.
Atopic Dermatitis: The Pipeline and Clinical Approaches That Could Transform the Standard of Care
September 24th 2025Patient Care tapped the rich trove of research and expert perspectives from the Revolutionizing Atopic Dermatitis 2025 conference to create a snapshot of the AD care of the future.
