看图诊病-恶性黑色素瘤?

 

A 63-year-old woman presented with an asymptomatic lesion on her left posterior upper arm that had been present for 18 years. Although the lesion was small initially, the patient noticed slow evolution over time. She had applied hydrocortisone to the area and thought there was some improvement because a whitish area developed within the lesion. She had no major medical history, including no personal or family history of skin disease. She was not taking prescription medications.

On physical examination, there was an irregular 4.2-cm by 3.5-cm pink plaque with areas of irregular pigmentation, primarily at the periphery. The lesion was located over the lateral aspect of the distal left triceps. A smooth area of depigmentation was noted along the inferior aspect of the lesion (Figure 1). There was no lymphadenopathy. The remainder of the physical examination was unremarkable.


 

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Lentigo maligna.

B. Solar lentigo.

C. Superficial basal cell carcinoma.

D. Superficial spreading melanoma.

Anser: D

From Am Fam Physician. 2015 Mar 15;91(6):389-390.