Derm Dx: Macule on the Cheek With Uneven Pigmentation - Clinical Advisor

Derm Dx: Macule on the Cheek With Uneven Pigmentation

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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.

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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...

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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.1,4 Behaviors 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.

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