History-The 52-year-old male patient was unaware of the lesion located on the skin of the back

of the neck. When questioned about prolonged sun exposure, the patient stated that he has
worked outdoor construction for more than 20 years. At the time of the dental visit, the patient
appeared to be in a good state of health, and no significant findings were noted during the
health history.
Examination- The extraoral examination revealed one lesion located on the skin of the back of
the neck. The lesion measured approx. 7mm in diameter and exhibited a rolled indurated (hard)
border with a depressed, crusted center. No other lesions were noted on the skin of the patient's
head and neck area, and no palpable lymph nodes were identified.
Melanoma- a malignant tumor of melanocytes, most arise on the skin as a result of prolonged
exposure to sunlight. Primary melanoma of the oral cavity is rare, however, melanomas that
arise on the skin may metastasize to the oral cavity. Usually presents rapidly enlarging, blue-to-
black mass, neoplasm demonstrates an aggressive and unpredictable behavior with early
metastasis, most common intraoral locations are the palate and maxillary gingiva. They may
change color, size, and shape. The mole may not be uniform, one half may look different from
the other, the border may be uneven or notched. These usually occur in adults older than 40
years of age.
This is not the correct answer because it was not stated that there was irregularity to it or that
the color played a significant role, it does not match the description of what was found.

squamous cell carcinoma- Early tumors may be white and plaque-like, red and plaque-like or a
mixture of red and white. May occur at the vermillion border, of the lips and skin of the face.
Most commonly matasisizes to lymph nodes of the neck presents as an exophytic ulcerative
mass, in this location, they are associated with sun exposure. The majority of squamous cell
carcinomas occur in men over 40.
This is not the answer because of the location where squamous cell carcinomas occur. Most
commonly in the oral cavity or on the lips, unlike our patient who presents with a lesion on his
neck. And while we could say that it possibly metastasized to his lymph nodes, it does not have
the same clinical characteristics of squamous cell carcinoma.

Basal cell carcinoma- Basal cell carcinoma is a malignant skin tumor associated with sun
exposure. It does not occur in the oral cavity and frequently arises on the skin of the face and
appears as a non-healing ulcer with characteristic rolled borders. The lesion develops a crusted
surface that suggests healing but the ulcer persists. Begins as a small ulcer but will enlarge
slowly with the destruction of underlying structures. most cases occur in white adults over the
age of 50 with Fair complexions with blonde or red hair and blue or green eyes.
This is the correct answer because the clinical description and appearance of our patient’s
lesion match the description of basal cell carcinoma. Having rolled borders with a crusted center
and being a relatively large lesion. Our patient is white which matches the descriptors. He also
most likely obtained this lesion from sun exposure which is associated with basal cell
carcinoma.
Seborrheic keratosis -
Seborrheic keratosis is a benign growth on your skin. Seborrheic keratosis is typically seen in
patients greater than 50 years of age and become more frequent as one ages. These growths
are dark-colored and raised, with a waxy, warty look. They develop in hair-bearing areas and
most commonly occur on the head, neck, trunk, and extremities. They can be caused by sun
exposure and can be hereditary. They are generally asymptomatic. Your healthcare provider
can often diagnose seborrheic keratosis with a physical exam. Most seborrheic keratoses don’t
need treatment. You can have them removed if they cause problems or you don’t like how they
look.

This isn’t the answer because the appearance of seborrheic keratosis, generally, is dark in color
and only changes when irritated or inflamed. Our patient didn’t realize it was there, yet it is
pinkish/red in color. Also, the description is a depressed and crushed center. In SK, the lesion is
raised and waxy.

Sun, M., & Halpern, A. (2021). Advances in the Etiology, Detection, and Clinical Management of
Seborrheic Keratoses.

Actinic keratosis-description, if it is the answer, why it is right or wrong

Actinic keratosis Is also known as solar keratosis, it grows slowly and usually first appears in
people over 40. It is precancerous and if left untreated, it can turn into squamous cell
carcinoma. Actinic keratosis is a rough, flat to slightly raised scaly patch or bumps on the skin
that develops from years of sun exposure. It is usually less than 1 inch in diameter. It's often
found on the face, lips, ears, forearms, scalp, neck, or back of the hands. The color varies
including pink, red, or brown. Symptoms include itching, burning, bleeding, or crusting.

This isn’t the answer mainly because the patient was unaware of the lesion. Actinic keratosis
has symptoms of itching and burning that make the patient aware of the lesion.

References:
Mallonee, L., Wyche, C., & Boyd, L. Wilkins' Clinical Practice of the Dental Hygienist. (13th ed.)
Ibsen, O., & Phelan, J. Oral pathology for the dental hygienist (7th ed.).
Sun, M., & Halpern, A. (2021). Advances in the Etiology, Detection, and Clinical Management of
Seborrheic Keratoses.