Non-Healing Facial Lesion — SCE Dermatology MCQ

Correct answer: A — Skin biopsy to exclude Bowen disease, superficial BCC, or other malignancy

The correct answer is A, skin biopsy to exclude Bowen disease, superficial BCC, or other malignancy. A well-demarcated erythematous patch on sun-exposed facial skin that persists and slowly enlarges over 6 months despite topical antifungals, with negative Wood lamp fluorescence and negative KOH microscopy, has effectively excluded a fungal or dermatophyte cause. Superficial basal cell carcinoma and Bowen disease (squamous cell carcinoma in situ) classically present exactly this way, as flat, scaly or non-scaly erythematous patches that are frequently mistaken for eczema, psoriasis, or tinea and only progress on treatment-resistant, chronic lesions in older patients. Because clinical morphology alone cannot reliably distinguish these malignant and premalignant patches from benign inflammatory dermatoses, histological confirmation is mandatory before further management. UK guidance on suspected skin cancer supports biopsy or dermatology referral for any persistent, unexplained skin lesion suspicious of malignancy rather than continued empirical treatment.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions