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Actinic Keratosis — SCE Dermatology MCQ

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HardSkin CancerActinic KeratosisSCE Dermatology

A patient with multiple scalp actinic keratoses develops one lesion that becomes rapidly thicker, tender and focally ulcerated. What is the most appropriate next step?

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Correct answer: CBiopsy or urgent specialist assessment for invasive squamous carcinoma

The best answer is “Biopsy or urgent specialist assessment for invasive squamous carcinoma”. Change from a stable field lesion to focal thickening, tenderness and ulceration raises concern for invasive SCC, so a numerical annual transformation estimate must not delay tissue diagnosis. The alternatives “Continue field emollients and review after one year”, “Treat repeatedly with cryotherapy without histology, within an appropriate UK pathway”, “Estimate risk from lesion count and offer reassurance”, “Begin topical corticosteroid for presumed inflammation, after specialist assessment” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: NICE NG12 suspected skin cancer recommendations: https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer#skin-cancers