I am preparing for a possible visit to a dermatologist regarding a red spot on my upper chest. I am thinking that I do not want any treatment for a condition that is diagnosed as pre-cancerous or cancerous without a biopsy. Question 1: Is this reasonable and fair?
I am asking because about four years ago I had a small red spot on my forearm. A dermatologist looked at it, declared it to be actinic keratosis (AK), and sprayed it with liquid nitrogen. I was very uncomfortable that no biopsy was performed. I became even more uncomfortable when I later learned that some doctors believe that it can be difficult to almost impossible to distinguish an AK from a squamous cell carcinoma (SCC) without doing a skin biopsy. Perhaps that dermatologist was right to skip the biopsy since I've seen no additional brown or red spots in that area, but this time I want to be better prepared and more involved in the decisions about my treatment.
Questions 2-3: Is it possible for the dermatologist to recommend surgery with a biopsy performed after the surgery? Can this be the best way to go, as opposed to biopsy followed by surgery?
Question 4: Have I missed the most important questions to ask? I will appreciate any suggestions for questions and, if the dermatologist indicates I may have skin cancer, a list of procedures to seek.
P.S. Just in case it makes a difference in the questions I should ask and the procedures I should seek, here is more info about the red spot. (Important: I am not looking for a diagnosis here.) I discovered the red spot (about 1/8 wide, 1/4 high) on my upper chest about a week ago. It looks like pictures of superficial basal cell skin cancer (and some pictures of squamous cell skin cancer). It is flat and has a sightly-raised, scalloped border with a smooth, shiny surface. No pain, no itch. I have treated it daily with Neosporin, alcohol, and Lamisil, but it is not significantly different. I fit the profile of people at high risk for skin cancer: super white skin that does not tan, at least three severe sunburns when young, now 63 years old.
FYI, I am asking 3-4 other experts this same question.
Answer red spot can be anything and nothing surely it is not a folliculitis or infected one since did not disapear with the treatment that you did apply.
Usually examination of the lesion give a clue on what it might be and according to your age and previous facial lesion it might be the same type.
actinic keratosis in deed do have a risk of cancerous transformation to a squamous cell carcinoma, but the external appearence can tell on the extension and transformation confirmed by a biopsy.
Dermatological biopsy are not always needed , and the choice of surgery or biopsy before is done depending on several factors as the shape , form, extension, ulceration, doubt and suspicious lesion, where surgery is done on bloc and pathology confirm, but sometimes a biopsy is needed for unknown type of lesions, and results determine the treatment especially if it is cancer type lesion where chemetherapy or radiotherapy is the alternative, since the lesion is extended over the surgical possibility of cure.
So to answer your question and since you do have several lesion [not in the same time but seems similar] I suggest you to take pictures first, do a biopsy, and if it is the same diagnosis as the first lesion, apply the same treatment as the first time, now if it is a squamous cell ca then surgical resection is suitable the faster the better with waiting for the path to see what will be next to do.
if it is actinic keratosis confirmed with a biopsy then expect to have more similar lesion all over your body with aging.Perform a biopsy on suspicious lesions with more pronounced hyperkeratosis, increased erythema, or induration.
A biopsy is also indicated for recurrent lesions or those that are unresponsive to therapy.
Obtain a biopsy sample of nodular, indurated, or recurrent lesions, and send it to a pathology laboratory to rule out a squamous cell carcinoma.
Histologic Findings: Histologically, epidermal changes are present and are characterized by acanthosis and dyskeratosis. The keratinocytes vary in size and shape and have many mitotic figures. Usually, marked hyperkeratosis and areas of parakeratosis with a loss of the granular layer are present. A dense inflammatory infiltrate may be present.
Actinic keratoses are the most common premalignant lesions in humans. The incidence is much higher in the Sun Belt and is directly related to light skin and sun exposure so try not expose you skin much to the sun.
Patients with actinic keratoses tend to have Fitzpatrick type I and II skin, which burns and does not tan. The incidence falls off precipitously in Fitzpatrick types III, IV, and V and is nonexistent in Fitzpatrick type VI.
The frequency of actinic keratosis is directly related to cumulative sun exposure. The age of occurrence is related to the skin type and the amount of sun damage
Usually, lesions develop as a single, small plaque on the face of patients aged 20-30 years with light coloring and significant sun exposure; they gradually progress in sun-exposed areas, such as the nose, the forehead, and the cheeks.
During periods of depressed immunity, the visible and the subclinical lesions flare and become erythematous and scaly. This depression of the immune system can occur following intense ultraviolet light exposure or with systemic chemotherapy for other carcinomas.
Over the years, the lesions gradually progress, and approximately 1 in 20 lesions eventually turns into invasive carcinomas. These lesions are typically the more erythematous, elevated, and indurated lesions. In very hyperkeratotic lesions, the invasive component of the carcinoma is at the base of the lesion and is often not seen until the physician removes the overlying plaque
Upon physical examination, patients have the changes of chronic sun damage.
They often have a blotchy, brown-freckled complexion with dilated blood vessels and multiple erythematous keratoses.
Usually, the lesions are concentrated on the sun-exposed areas, such as the forehead, the temples, the nose, and the cheeks. However, the lesions can be seen on any chronically sun-exposed part of the body, such as the arms and the legs, especially in sunbathers or patients who frequently use tanning booths.
Truncal actinic keratoses are seen in persons, such as sailors, who are chronically exposed to the sun in these areas.
