Lessons in Follow-Up and More
A new patient (below), a 60-year-old woman, presented for "spongiotic dermatitis" diagnosed after a biopsy in March 2011. At the time, she received cortisone cream and no follow-up appointment. She comes to my office because she is concerned that the spot never went away and now it is very sore and tender. A shave biopsy shows this to be nodulocystic basal cell carcinoma.
This case is a friendly reminder that follow-up appointments are absolutely necessary to providing quality patient care. You can always tell the patient that "If you feel the spot/lesion/rash has 100% resolved by your follow-up appointment you may cancel, but as soon as you notice something developing/growing please return to the clinic as soon as possible." This unfortunate patient just assumed she had a "funny rash" that never went away.
I always inform patients that "My dermascope informs me if your condition is still lingering or has completely resolved, so I prefer you return for your follow-up appointment even if you think it's gone."
I saw this patient (below) for a full-body exam 6 weeks ago. He presented last week with this new, incredibly rapid growing nodule behind his left ear. I was shocked by how fast it grew and was certain it was a basal cell carcinoma. I even scheduled him for MOHS that day! Two days later, the lesion was biopsied and proven to be a benign pilomatrixoma.
Pilomatrixomas are single tumors derived from hair matrix cells and may closely resemble an epidermoid cyst. They can also present in a malignant form. This patient will be monitored and re-checked in 90 days.
This 66-year-old man (below) presents with a growing "bump" that he believes began 2 years ago. Diagnosis: nodular basal cell carcinoma.