How do you treat this asymptomatic lesion?

A 63-year-old woman comes to you for a second opinion after a plastic surgeon recommends excision of an asymptomatic lesion that has been growing in the part line on the top of her scalp for several months. There is no personal or family history of skin cancer, and the patient has no similar lesions.

Your next step is to . . .

A. Reassure the patient and send her home.

B. Perform a punch biopsy.

C. Perform a shave biopsy.

D. Excise the lesion.

E. Refer the patient to a dermatologist.

Answer: Seborrheic keratosis

This is a seborrheic keratosis, a common, benign tumor that can erupt on the face or trunk of persons older than age 30. Reassurance, A, is the only treatment necessary.

If the atypical appearance of the lesion concerns you or you are uncertain of the diagnosis, refer the patient to a dermatologist or perform a punch or incisional biopsy of the lesion’s most atypical region. Histopathologic examination of the specimen will confirm the diagnosis.