An in the park home run

06/17/2009 at 4:58 AM Leave a comment

This older gentleman came in for a large bump on his hand. It looked like it was sore spot he could not leave alone. He admitted that he ‘worried’ it some. I froze it with Cryosurgery and told him to come back if it did not get better.  The lesion mostly went away but for a very short time and the patient returned. This time I biopsied  it  (see yesterday’s post) and it returned as lichen planus, that is, he worries the area and irritates it. Great no problem and  since it continued to  bother him, I just needed to remove it and he is healed.

Because the freezing did not work , I suspected that it was deeper than usual and I removed it  “in toto”. That is I cut it out whole. He had lots of loose skin so it was not a challenge. He tolerated the procedure well, there was no complications. Then the moment of decision. I had a large lesion that had just been proven to be a benign irritation. Normally I would just toss it without a second’s thought, but for some unknowable reason, I hesitated and on reflection decided to send it for pathology. To this day I dont know why. 

Two weeks pass and imagine my surprise when the report said that while the vast majority of the lesion was Lichen planus, there were small hidden areas that were SQUAMOUS CELL CARCINOMA. I was stunned, I was also thrilled. The margins were clear which meant that I had removed the entire thing. He needs surveillance but we got that lesion. 

It does bring to mind a question: What is the usefulness of a biopsy if it is going to miss things like this? Or is it just the capriciousness of  humans and there will always the things that slip through our best efforts?

Unlike in yesterday’s case, I can feel good about catching something very difficult today. We shall see what tomorrow brings.

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Entry filed under: Uncategorized.

A Miss and a Save aka better lucky than good What a week!

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