Derm Dx: Macule on the Cheek With Uneven Pigmentation

Slide

Case Study:
Explanation:

A 64-year-old Hispanic man presents with a pigmented area on his left lower cheek that has gradually enlarged and darkened over the past year. Family and personal history are negative for skin cancer. Examination reveals a 1.5-cm, well-delineated macule with uneven pigmentation. A seborrheic keratosis is also noted on his back. Cervical and submandibular lymph nodes are nonpalpable.

Can you diagnose this condition?

Biopsy of the lesion revealed melanoma in situ; the lesion was excised with a 0.5-cm border. The lifetime risk of developing melanoma is 1 in 38 for non-Hispanic whites and 1 in 173 for Hispanics.1 However, the incidence of melanoma...

Submit your diagnosis to see full explanation.

Biopsy of the lesion revealed melanoma in situ; the lesion was excised with a 0.5-cm border.

The lifetime risk of developing melanoma is 1 in 38 for non-Hispanic whites and 1 in 173 for Hispanics.¹ However, the incidence of melanoma in Hispanics is increasing; from 1992 to 2008, cases of melanoma in this population in the United States rose by 19%.² Hispanic individuals are 2.4 times more likely to present with advanced disease.¹ Skin type in this population ranges from very light type I skin to very dark type VI skin.³ Factors that may contribute to delay in diagnosis include misconceptions about melanoma risk and lack of access to specialized care.^1,4Behaviors such as not wearing sunscreen, spending time in the sun, and tanning bed use increase the risk for melanoma.²

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Infographic: skin cancer stats in Hispanic patients. Cutis. https://www.mdedge.com/dermatology/article/203885/melanoma/infographic-skin-cancer-stats-hispanic-patients?utm_source=Clin_Derm_eNL_070419_F&utm_medium=email&utm_campaign=2009&pu=284b52e536d3751f14e0847ce7cc3de0. Published July 1, 2019. Accessed July 17, 2019.

2. Coups EJ, Stapleton JL, Hudson SV, et al. Linguistic acculturation and skin cancer-related behaviors among Hispanics in the Southern and Western United States. JAMA Dermatol. 2013;149(6):679-686.

3. Agbai ON, Buster K, Sanchez M, et al. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748–762.

4. Harvey VM, Oldfield CW, Chen JT, Eschbach K. Melanoma disparities among US Hispanics: use of the social ecological model to contextualize reasons for inequitable outcomes and frame a research agenda. J Skin Cancer. 2016;2016:4635740.