A 76-year-old woman sought medical attention for an asymptomatic “red spot” on her anterior neck. She had a history of multiple non-melanoma skin cancers.
Key point: Physical examination revealed a 0.85 cm by 0.6 cm red patch on the anterior neck. The differential diagnosis includes: squamous cell carcinoma in-situ (Bowenghs disease), superficial basal cell carcinoma, lichenoid keratosis (an inflammatory variant of seborrheic keratosis), and insect bite. Biopsy showed lichenoid keratosis.
Treatment: Once daily topical application of 2.5% hydrocortisone cream led to uneventful healing.
Note: This case demonstrates the ambiguity in clinical morphology. When in doubt, you should always do a small skin biopsy!