My daughter has a painless and non-itchy skin lesion on her chest for ten months. Please help.

Question

Hi doctor,

My daughter is very pale with blond hair and light grey eyes. She does not get any tan. She has a skin lesion on her chest, which developed over the last ten months. She also has swollen lymph nodes in her neck. What do you think this can be? She has no pain or itching, and the lesion is just over 1 cm x 1 cm in size. Please explain.

Answer 1

Hi,

Welcome to icliniq.com.

I understand the concern. After seeing the photograph (attachments removed to protect the patient's identity), I can give you some differentials, and you will still need a biopsy finally to rule out or confirm it. The differential, in this case, can be angiokeratoma and spitz nevus. Both are benign, harmless conditions, and we need to rule out their malignant counterparts like angiosarcoma and atypical spitz nevus. Another thing to rule out is the verrucous hemangioma. It is not easy to give a definitive diagnosis in such cases, and a biopsy is required to confirm the final diagnosis. So get a skin biopsy done as and when possible and follow up. Take care.

Answer 2

Hi,

Welcome back to icliniq.com.

Yes, I thought of basal cell carcinoma, too, as the initial lesion looks like that. Basal cell carcinoma usually ulcerates and has crust formation. And in the photo, it looked more like scaling, so I did not include it. But yes, it needs to be ruled out indeed. If one sees only the first lesion, basal cell carcinoma is undoubtedly a differential diagnosis. So basically, a skin biopsy is a must in this situation to ascertain the nature here (benign or malignant). Take care.