From the Guidelines
The workup for a lesion of unspecified origin should begin with a history and physical examination, including a complete skin examination, followed by a skin biopsy if the lesion is suspicious. The initial evaluation should focus on characterizing the lesion's appearance, location, duration, associated symptoms, and risk factors. According to 1, a full skin examination is recommended because individuals with a skin cancer often have additional, concurrent precancers or cancers located at other, usually sun-exposed skin sites. Key aspects of the physical examination include:
- Documentation of the lesion's size, color, borders, texture, and any changes over time
- Assessment of the lesion's location and potential impact on surrounding tissues
- Evaluation for signs of infection, inflammation, or other complications If a biopsy is necessary, it should include deep reticular dermis if the lesion is suspected to be more than a superficial process, as an infiltrative histology may sometimes be present only at the deeper, advancing margins of a tumor 1. Imaging studies, such as MRI or CT scan, may be performed when extensive disease is suspected, with MRI preferred over CT scan if perineural disease is suspected due to its higher sensitivity 1. Ultimately, the specific workup should be tailored to the individual presentation and clinical suspicion, balancing the need for accurate diagnosis with the potential risks and benefits of each diagnostic procedure.
From the Research
Workup for a Lesion of Unspecified Origin
The workup for a lesion of unspecified origin may involve various diagnostic procedures to determine the nature and cause of the lesion.
- A deep shave biopsy of the lesion may be obtained to examine the histological features, as seen in a case of nodular hidradenoma 2.
- Imaging studies such as CT or MRI scans may be used to evaluate the lesion and guide further diagnosis, with a diagnostic accuracy of 94.4% for histopathological analysis and 97.7% for microbiological analysis 3.
- Contrast-enhanced ultrasound (CEUS) may be used to evaluate hepatic echinococcosis, with a sensitivity and specificity of 100% compared to MRI, CT, or FDG-PET-CT 4.
- Parametric imaging in (18)F-FDG PET/CT dynamic multi-bed scanning may be used to differentiate between malignant and benign pulmonary lesions, with a high correlation between the influx rate constant Ki and maximum standardized uptake value (SUVmax) 5.
- Advanced practice nurses may play a role in skin cancer assessment, but may face barriers such as limited time to conduct skin examinations, and may benefit from targeted training to increase their skills in recognizing and referring suspicious skin lesions 6.