Patient Presents with Skin Lesion on Hand: Diagnostic Considerations and Potential Causes

• Patient Presents with Skin Lesion on Hand: What is Your Diagnosis?

A patient arrives at the clinic with a noticeable skin lesion on their hand. The lesion is a raised, rough patch that has been gradually increasing in size over the past few months. The patient reports occasional itching and discomfort in the affected area. Upon examination, the lesion appears to be well-demarcated and has a scaly surface.

Clinical Presentation

The patient's primary symptoms include:

• Raised, Rough Patch: The lesion is elevated above the surrounding skin and has a rough texture.

• Itching and Discomfort: The patient experiences occasional itching and discomfort, which may indicate an underlying inflammatory process.

• Scaly Surface: The lesion has a scaly appearance, suggesting possible keratinization or chronic irritation.

Differential Diagnosis

Given the patient's symptoms and the appearance of the lesion, several potential diagnoses should be considered:

1. Actinic Keratosis: This condition is caused by long-term sun exposure and appears as thick, scaly patches on the skin. It is a precursor to squamous cell carcinoma.

2. Psoriasis: A chronic autoimmune condition that leads to the rapid buildup of skin cells, resulting in scaly, red patches that can be itchy or painful.

3. Eczema: This includes various types of dermatitis that cause inflamed, itchy, and sometimes scaly skin patches.

4. Squamous Cell Carcinoma: A type of skin cancer that can present as a rough, scaly patch or a firm red nodule.

5. Warts: Caused by human papillomavirus (HPV), warts can appear as rough, raised patches on the skin.

Diagnostic Workup

To determine the underlying cause of the skin lesion, the following diagnostic tests and evaluations are recommended:

• Skin Biopsy: A sample of the lesion can be taken for histopathological examination to identify the exact nature of the cells.

• Dermoscopy: A non-invasive technique that uses a dermatoscope to examine the lesion's surface and vascular patterns.

• Blood Tests: To rule out underlying systemic conditions that may contribute to skin changes.

• Patch Testing: If eczema or allergic contact dermatitis is suspected, patch testing can help identify potential allergens.

Conclusion

The patient's presentation with a raised, rough, and scaly skin lesion on the hand necessitates a thorough diagnostic workup to determine the exact cause. Early diagnosis and appropriate treatment are crucial for managing the condition and preventing potential complications. Regular follow-up and monitoring are essential to ensure the patient's skin health and overall well-being.