In the store-and-forward teledermatology modality, there is a transfer of patient medical information electronically (including history and visual data) obtained in one location to a provider who is in another location (Roman & Jacob, 2015). The construct of the Teledermatology Viewpoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report.
TELEDERMATOLOGY READER REPORT1
HISTORY:
Chief complaint: Presenting for diagnosis of skin lesion and therapeutic options.
History of present illness:
A 59-year-old man complains of a firm, pink, and crusted nodule on the lateral right arm that grew rapidly over the last 3 months. Prior treatment: None. Prior biopsy: None. Skin history: No history of skin cancer. He routinely works outside and does not apply sunblock or wear sun protective clothing.
IMAGE QUALITY ASSESSMENT
Fully satisfactory.
TELEDERMATOLOGY IMAGING READER REPORT
There is one image provided with this consult. The image shows a firm, pink crateriform nodule with a dark, crusted keratin-filled center on the lateral side of the right arm near the elbow (see Figure 1).
INTERPRETATION OF IMAGES
Lesion A: Findings: The morphology of the lesions, distribution, and history are characteristic for keratoacanthoma (KA).
RECOMMENDATIONS
Referral to dermatology for shave biopsy to confirm diagnosis and determine treatment.
CLINICAL PEARL
KA is a cutaneous neoplasm that originates in hair follicles and is characterized by cycles of rapid growth and resolution, which typically occurs over 4-6 months and consists of a proliferative, mature, and involutional stage (Watanabe et al., 2015). In the proliferative phase, rapid growth takes place for approximately 6-8 weeks (Zito & Scharf, 2020). KA presents as a squamous proliferative lesion that begins as a solitary, firm, skin-colored, or erythematous papule, which progresses to a crateriform architecture with a central keratin-filled center that may project as a horn (Chuang, 2020; Misago et al., 2013). KA can develop from multiple etiologies, such as ultraviolet radiation, trauma or local injury, chemical carcinogens, human papillomavirus, genetic factors such as mutations in p53 or H-Ras, and immunosuppression. Most KAs occur on the face, head, neck, and dorsum of extremities in sun-exposed, hair-baring areas (Zito & Scharf, 2020).
KAs are commonly understood as a subtype of squamous cell carcinoma (SCC). However, the rapid growth and subsequent period of involution are a hallmark of KAs and suggest a separate and distinct biological process from SCC (Misago et al., 2013). A shave biopsy confirms the diagnosis. The term KA-like SCC refers to the specific subset that histopathologically resembles KA but has anomalous architecture and cytological features (Misago et al., 2013). KAs have an excellent prognosis following excisional surgery (Chuang, 2020).
NURSING PERSPECTIVE
Nurses interact with the public in many diverse settings and are often the first healthcare professionals to examine a patient's skin. Each encounter presents as an opportunity to screen and educate patients. Prevention methods are similar to SCC and include the use of broad-spectrum chemical or physical sunscreens, practice of sun-protective behaviors such as seeking shade, wearing sun protective clothing like broad-brimmed head coverings, and tanning bed avoidance (Work Group et al., 2018).
REFERENCES