“healthy” appearance.
Seth, a thirty-eight year-old white male of Scandinavian descent, has lived his entire life in Southern Florida. He is very concerned with maintaining a “healthy” appearance. Seth is very athletic and especially enjoys surfing. He has been surfing since the age of twelve and he started making surfboards while he was in high school. After obtaining a college degree in marketing Seth decided to start his own business making surfboards and giving surfing lessons for a local resort near his home. During a routine physical examination the physician assistant that Seth sees commented on the presence and appearance of a small growth (approximately 2-cm in diameter) above Seth’s right eyebrow. This growth was shiny with a pearly border, a central ulcer and engorged surface blood vessels. The physician assistant was concerned that this might be a tumor and asked Seth a number of questions to aid in the diagnosis. Seth reported that he noticed this growth approximately six months ago but thought nothing about it since he often developed “pimples” when he was working on surfboards because of the heat and dust. Seth noticed that the growth would occasionally bleed, but he thought the bleeding most often occurred when he absently scratched above his eyebrows when he was working. Seth also reported that after bleeding the growth would “crust over” and appear to heal, but not disappear. Seth also thinks the lesion has increased in size, but he can’t be certain.
The physician assistant asks Seth to come back in two days to visit with the attending physician and encourages Seth to be sure to use sunscreen whenever possible, especially when he is surfing or teaching surfing classes. Upon returning to see the physician, Seth is told that he probably has a basal cell carcinoma. This, the physician explains, is a cancer that while not benign, rarely metastasizes and grows very slowly. This type of cancer usually occurs in areas that have the greatest exposure to the sun (i.e. the face, head, and neck). While this cancer would probably not metastasize, the physician suggests surgical removal to minimize damage to any underlying tissues and a histological examination of the excised tissue to confirm the diagnosis.
