This patient was first seen in the office with a red scaly lesion on the arm that appeared to be a precancerous keratosis. It was treated with liquid nitrogen and the patient was instructed to return in six weeks if it hadn’t cleared. Instead the patient submitted this photo to our website. It appeared to be a scab and since the patient was on blood thinners, we thought it was probably ok being so large and dark. Fortunately he returned to the clinic two weeks later as instructed when the scab did not resolve. A biopsy was done and showed an ulcerated, amelanotic melanoma which is an extremely dangerous tumor. This was treated surgically and he has been well since the surgery eighteen months ago.
If this patient was not able to follow up promptly in the office for a biopsy, this life threatening skin cancer may have been much more advanced when finally treated. Practicing teledermatology without office back up should not be considered within the standard of care.