Scabby lesion on ear

Older white person, scab that won’t heal on sun exposed skin, think basal cell cancer.

There isn’t much to see, but let me show you a little dermatologist’s tactic, tensioning the skin gently with two digits.

As the firm pressure squeezes the blood out, a pale, waxy plaque becomes visible. This is an infiltrated nodular basal cell cancer. Dermoscopy isn’t necessary, but let’s do it anyway.

Classical focused branches serpentine vessels at the centre are obvious, but similar smaller vessels extend to the edge of the field of view, and there are also multiple micro-erosions which are seen as pale yellow clods. You might have noticed a wiggly dark line on one of them, near the 5 on the graticule. This is a piece of clothing fabric. The clothing fibre sign indicates ulceration, as clothing fibres stick to fibrin that leaks out of broken skin. It can help to visualise erosions too small for the unaided eye to notice.

Biopsy proven, will require skilled reconstruction surgery. NB probably took 3 years to reach this size. Such tumours grow silently, with no symptoms until they start to scan