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Skin Graft Failure — SCE Dermatology MCQ

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HardDermatological SurgerySkin Graft FailureSCE Dermatology

A rapidly growing crateriform nodule on a sun-exposed forearm has a central keratin plug. Clinical appearances favour keratoacanthoma, but invasive SCC cannot be excluded. What is the preferred management?

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

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Correct answer: C — Complete excision with histological assessment using margins selected for suspected cSCC

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

B is correct. Keratoacanthoma lies within the clinical and pathological spectrum of well-differentiated cSCC, and partial sampling may not show the architecture needed to distinguish it. A suspicious rapidly growing crateriform lesion is therefore generally excised completely and submitted for histology, with margins appropriate to the clinical cSCC risk. Spontaneous regression can occur but observation risks undertreating invasive malignancy. Superficial curettage may destroy diagnostic architecture, while corticosteroid treatment does not resolve the oncological uncertainty.

Reference: British Association of Dermatologists guideline for cutaneous squamous-cell carcinoma: https://doi.org/10.1111/bjd.19621