Sneaky skin cancers

I’ve been fooled recently. I’ve been fooled by abnormal skin lesions of patients, and I’m not afraid to admit it. I see a good bit of dermatology in my practice, as I’m usually at the front line of diagnosis for my patients.

Here are three recent cases that surprised me.

The first is of a longstanding patient of mine – an elderly white gentleman with a rash on his scalp that we’d frozen lesions off of before, and treated as a combination of “cradle cap” and actinic keratosis, which is essentially sun damaged skin. He returned for evaluation of one lesion on the scalp that seemed to be growing much larger than the others. It was mountainous, yellow and greasy, just like a severe case of cradle cap, and similar to what some babies have.

However, since it was bothersome to him, we decided to take it off by doing an excisional biopsy. We numbed it up and cut it off and sent it to the pathology lab to grow. It returned showing squamous cell carcinoma in situ. This is a precancerous type of lesion that potentially can become cancer. Squamous cell carcinoma in situ has a high probability of becoming true carcinoma. We sent him to a dermatologist for follow up, and he is doing well.

The second patient is an elderly black gentleman I saw with our physician’s assistant. She brought him to my attention for a fairly normal-looking mole on his forehead. He’d had it for years, but it recently started changing in size, shape and color. He had no family history of skin cancers, but due to the recent changes, we agreed to do an excisional biopsy.

Guess what it turned out to be? Squamous cell carcinoma! Not in situ again but true carcinoma. That was truly surprising, particularly since he is African-American, a group that skin cancer doesn’t normally affect, and he had no family history.

The last one is actually a patient of my colleague that he brought to my attention. This is a young, white gentleman who came in for what he thought was “pink eye.” There was a dark spot beginning in the sclera or the white part of the eye, moving into the inside of the lower eyelid. It wasn’t painful, but it was new and had increased over the last couple of weeks. He had no family or personal history of skin lesions or cancers.

The first person that saw him in our practice thought enough to send him to an eye doctor that biopsied the lesion. When he returned to my colleague, guess what it turned out to be? Melanoma!

I never would have imagined skin cancer beginning in the eye. He had no other lesions on the skin that would have sparked the thought of skin cancer. I was able to see the patient and see the original lesion in the eye that was biopsied. I’ll never forget that case, and I’ll now pay even more attention to everyone’s eyes when I examine them.

The point is, skin lesions can be sneaky, and are more often more than meets the eye nowadays. This is not to say every mole, spot or skin tag is cancer, but if there is significant change in color, shape or size over a matter of months, it needs to be evaluated by your doctor. Don’t ignore your body. It may be trying to tell you something.

Dr. C. Nicole Swiner works at Durham Family Medicine, where she treats newborns to elderly patients. She and her colleagues are accepting new patients and can be found at

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