Basal cell cancer on back of hand
This lesion presented with a vague history and I was initially uncertain what it was. Suspected Bowen’s disease and biopsied.
Histology was nodular basal cell carcinoma. Here is the dermoscopy.
Looking again (this picture was taken at review), I was amazed how I had missed these obvious signs of BCC. Observe the pearly background, classic arborising vessels, and ‘leaf like’ pigmented blue grey structures at 2 and 7 o’clock.
Stuff changes over time, uncertainty exists, and, believe it or not, we all make many mistakes (letter of James, chapter 3 verse 2). Always be careful and aware that you might get it wrong. That is where having understanding colleagues and a no-blame (but still accountable) team scores so high.
Treatment: excision with adequate margin, watching out for the big veins on the back of the hand.