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 a diagnosis of skin lesion and therapeutic options.
History of Present Illness
A 73-year-old man complains of a rapidly growing, firm, crusted, red-violet, and telangiectatic cutaneous nodule on the forearm. Prior treatment: none. Prior biopsy: none. Skin history: no history of skin cancer. He is retired and regularly enjoys hiking and outdoor activities. He is averse to wearing sunblock and sun-protective clothing.
IMAGE QUALITY ASSESSMENT
There are image quality issues, but images readable from a teledermatology perspective.
TELEDERMATOLOGY IMAGING READER REPORT
There is one image provided with this consult. The image shows a firm, red-violet, crusted, and telangiectatic cutaneous nodule on the right forearm (see Figure 1).
INTERPRETATION OF IMAGES
Lesion A
Findings
The morphology, distribution, and history of the lesions are characteristic for Merkel cell carcinoma (MCC).
RECOMMENDATIONS
Referral to dermatology for biopsy to confirm diagnosis and determine treatment.
CLINICAL PEARL
MCC is a rare and aggressive neuroendocrine cutaneous malignancy that has been increasing in incidence (Emge & Cardones, 2019). The pathogenesis of MCC is most often associated with the Merkel cell polyomavirus or chronic ultraviolet light exposure that induces DNA damage (Becker et al., 2017). MCC clinically presents as a rapidly growing, solitary lesion with early crusting and ulceration and commonly appears as a red-violet, firm, dome-shaped nodule found on sun-exposed areas of the body. MCC can also be pleomorphic and appear plaque-like or as a flesh-colored subcutaneous nodule (Xue & Thakuria, 2019). Significant clinical features of MCC can be summarized with the acronym AEIOU: asymptomatic/lack of tenderness, expanding rapidly, immune suppression, older than 50 years, and ultraviolet-exposed site on a person with fair skin (Heath et al., 2008). A 2016 study of prognostic factors from 9,387 MCC cases reported that the 5-year overall survival rate is 51% for the local disease, 35% for the nodal disease, and 14% for the distant disease (Harms et al., 2016).
NURSING PERSPECTIVE
The innocuous appearance of MCC frequently results in misdiagnoses as benign lesions such as cysts or other malignant lesions such as cutaneous squamous cell carcinoma or lymphoma (Becker et al., 2017). Nurses play an important role in screening and referral to dermatology.
REFERENCES