A 78-year-old retired farmer shows you the lesion below, which he has noticed on his arm. What would be the most appropriate management of this lesion?
**Core Concept**
The patient's lesion is likely a basal cell carcinoma (BCC), a type of skin cancer that arises from the basal cell layer of the epidermis. BCCs are the most common form of skin cancer and are often associated with exposure to ultraviolet (UV) radiation from the sun or tanning beds.
**Why the Correct Answer is Right**
The management of BCC involves surgical excision, which involves removing the tumor along with a margin of normal skin to ensure complete removal of the cancerous cells. Mohs surgery, a type of surgical excision, is often preferred for BCCs due to its high cure rate and ability to preserve surrounding tissue. The procedure involves removing the tumor in layers, with each layer being examined under a microscope until no cancer cells are found.
**Why Each Wrong Option is Incorrect**
* **Option A:** Chemotherapy is not typically used as a primary treatment for BCC, as it is usually effective against more aggressive forms of skin cancer.
* **Option B:** Radiation therapy may be used in certain cases of BCC, such as when surgical excision is not possible, but it is not the most appropriate initial management.
* **Option D:** Topical treatments, such as imiquimod, may be used to treat superficial BCCs, but they are not suitable for more aggressive or invasive forms of the disease.
**Clinical Pearl / High-Yield Fact**
BCCs are often associated with a characteristic "pearly" appearance and can be mistaken for other skin conditions, such as eczema or psoriasis. It's essential to perform a thorough examination and biopsy to confirm the diagnosis.
**Correct Answer: C. Mohs surgery**