Clinical Application Questions

A 70-year-old man is seen at your office for multiple raised pigmented lesions over his back and chest. These have developed gradually over several years. There are two lesions on the mid-lower back that intermittently itch intensely and are somewhat larger and much darker than the other lesions, which number 50 or more. Physical examination of the entire region reveals multiple seborrheic keratoses. Except for the two lesions in question there are no other suspect lesions. The patient is very worried about melanoma.

1. Should the two darker lesions be biopsied for melanoma?

2. If you determine that one or both of the darker lesions are seborrheic keratoses, what should you tell the patient about them?

3. What are the primary lesions that you would expect to find with seborrheic keratoses?

4. What are the secondary lesions that you would expect to find with seborrheic keratoses?

5. If you determine that one or both of the darker lesions are seborrheic keratoses, how should you treat them?

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