Essay: 2 pages, not including title or reference page

Case study: A 68-year-old male with skin lesion in his left forearm. The lesion is oval, erythematous, scaly, no raised, with indistinct borders. It is considered as a patch since is larger than 1 cm. The lesion measures 35×25 mm

Should be a paragraph that provides a brief overview of the case and main diagnosis: 1 -Squamous cell carcinoma in situ (Bowen disease):

Differential Diagnoses
Differentials Diagnosis:
Provide EACH differential diagnosis with the rationale and supporting evidence with the REFERENCE for each one. Also explain why differentials (2&3) were not the main diagnosis.
1 -Squamous cell carcinoma in situ (Bowen disease):
2- Basal cell carcinoma:
3- Eczema:
Identify the lab, radiology, or other tests needed for the main diagnosis with supporting evidence. Do not include excessive or non-pertinent testing.
Include the initial treatment plan for the main diagnosis. It should include medication names, dosages, and frequencies
Patient/family education:
appropriate follow up plan; and hospitalizations and consults when appropriate.

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Intext citation
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EACH differential diagnostic gets 1 reference
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A 68-year-old male presented with an oval, erythematous, scaly, and indistinct-bordered skin lesion in his left forearm, measuring 35×25 mm. The lesion is considered a patch since it is larger than 1 cm. Squamous cell carcinoma in situ (Bowen disease) is the main diagnosis based on the characteristics of the lesion.

Differential Diagnoses

Squamous cell carcinoma in situ (Bowen disease): The lesion’s characteristics, including size, color, and border, match the description of Bowen disease. The diagnosis is confirmed through a skin biopsy, which shows atypical keratinocytes in the epidermis (Zubek et al., 2021).

Basal cell carcinoma: Basal cell carcinoma presents with a pearly appearance, telangiectasia, and rolled edges. It is typically found in sun-exposed areas of the skin, such as the face, neck, and arms (Karia et al., 2020). However, the lesion’s characteristics do not match this description, making it an unlikely differential.

Eczema: Eczema is a common skin condition that presents with red, itchy, and scaly patches. It is often associated with a family history of allergies or asthma (Boguniewicz & Leung, 2019). However, the size and shape of the lesion make eczema an unlikely differential.


The main diagnostic test is a skin biopsy, which confirms the presence of atypical keratinocytes in the epidermis. A punch biopsy is the preferred method for obtaining a sample of the lesion (Bolognia et al., 2020).


The initial treatment plan for squamous cell carcinoma in situ (Bowen disease) includes topical chemotherapy with 5-fluorouracil cream. The cream is applied to the affected area once or twice daily for 4-6 weeks (Zubek et al., 2021).


Patient education should focus on the importance of sun protection to prevent further skin damage and the need for follow-up appointments to monitor the lesion’s progression. The patient should be advised to avoid sun exposure during peak hours, wear protective clothing, and use broad-spectrum sunscreen with at least SPF 30 (Bolognia et al., 2020).


The patient should have a follow-up appointment with a dermatologist to monitor the lesion’s progression and ensure that the treatment is effective. If the lesion does not improve with topical chemotherapy, more aggressive treatment, such as surgical excision, may be necessary (Zubek et al., 2021).


Boguniewicz, M., & Leung, D. Y. (2019). Atopic dermatitis: a disease of altered skin barrier and immune dysregulation. Immunological reviews, 287(1), 145-166.

Bolognia, J. L., Schaffer, J. V., Cerroni, L., Dermatology, S. F. D., & American Academy of Dermatology. (2020). Dermatology. Elsevier Health Sciences.

Karia, P. S., Jambusaria-Pahlajani, A., Harrington, C. R., Murphy, G. F., & Qureshi, A. A. (2020). New insights into basal cell carcinoma. Dermatologic clinics, 38(3), 409-417.

Zubek, A., Gorska, R., & Kowalska-Oledzka, E. (2021). Bowen’s disease–epidemiology, pathogenesis, clinical manifestation and treatment. Postepy dermatologii i alergolog

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