More than meets the eye

Ideally, examine any abnormal pigmented lesion with a dermatoscope. This was a pigmented Bowen’s disease or SCC in-situ, meaning it only involves the epidermis. The pigmentation is due to increased melanin in the keratinocytes rather than increased melanocytes or naevus cells. A flat lesion like this can be shave biopsied to confirm the diagnosis then treated with Efudix cream for four to six weeks or imiquimod cream for six weeks.

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