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Wound Biofilm — SCE Dermatology MCQ

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HardWound HealingWound BiofilmSCE Dermatology

A rapidly growing crateriform tumour on the dorsal hand is reported on partial shave biopsy as “features favour keratoacanthoma; invasive cSCC cannot be excluded”. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Excise completely for histology with margins based on clinical cSCC risk

Explanation lettering: E = shown as A · D = shown as B · A = shown as D · B = shown as E

E is correct. Keratoacanthoma and well-differentiated cSCC overlap clinically and histologically, and a partial shave may omit the deep architecture needed to distinguish them. On a high-risk hand site, unresolved invasive malignancy should be managed with complete excision and examination of the whole lesion using margins selected for the clinical cSCC risk. Waiting for regression can delay treatment of SCC. Additional superficial sampling or destructive treatment can again remove the architecture without resolving invasion. Clinicopathological correlation and skin-cancer MDT discussion are appropriate when risk remains uncertain.

Reference: BAD guideline for cutaneous squamous-cell carcinoma: https://doi.org/10.1111/bjd.19621