A 68 year old man comes to you with the lesion shown below on his face. he has recently had a tick bite and since then has had an itching feeling on this lesion. There is no oozing from it and the scaly part feels rough. He has peeled off the scaliness on a couple of occasions but it re-appears.

Which of the following measures is NOT reasonable to perform?

1. Cryotherapy

2. Excision biopsy

3. Application of a chemotherapeutic agent

4. Wide excision of the lesion because it is persistent.

Answer is 4. Of the above - it is the only measure that is not reasonable without a confirmed diagnosis of a cancer.

This lesion is an Actinic Keratosis. It is precancerous. About 20% have SCC sitting in them. Treatment is Cryotherapy.  3% of SCC will metastasize.

When widespread, use 5FU cream before deciding which ones need to be frozen.

Surgery of persistent lesions is indicated -  usually after atleast one of the above two measures have failed - because resistant lesions have a higher incidence of having a cancer in them.