If you’re into crime fiction, you’re all too familiar with suspicious persons or persons of interest. At Deschutes, Dr. Carter is more concerned with suspicious lesions.

OK, most lesions don’t fall into the “suspicious” category. It’s not like they’ve been hanging around the crime scene, have definite motives, or have been known to use aliases. Most of them don’t require any special treatment. But Dr. Carter will weigh the evidence against said lesion, considering how long it’s been there, if it has changed in some way, if it has started bleeding, or is tender.

What are the signs of a lesion being “suspicious?”

A skin lesion is a part of the skin that has an abnormal growth or appearance compared with the skin surrounding it. They are broken into two categories: primary or secondary. Primary skin lesions are abnormal skin conditions that are either present at birth (a birthmark, for instance) or are acquired during a person’s life. Secondary skin lesions are the result of irritated or manipulated primary skin lesions. Crusting and scaling are common secondary skin lesions.

Dr. Carter usually is suspicious of skin lesions that are showing signs of skin cancer

  • Basal cell carcinomas will show signs of bleeding, ulceration, and will be locally destructive. They don’t usually spread, but are removed for the patient’s safety.
  • Squamous cell carcinomas occur mainly on the areas of the skin that receive tons of sun: the head, arms, back of the hands, and the back of the neck. Squamous cell carcinomas can spread to other parts of the body, so their diagnosis and removal is key.
  • Melanoma doesn’t necessarily occur on areas of enduring sun exposure. Research shows that the risks of melanoma rise dramatically due to the number of “extreme” sunburns a person has had. They also have a genetic trend, and occur in people with large numbers of moles. Melanoma is the most dangerous skin cancer, as it can spread to all parts of the body and metastasize there.

How does Dr. Carter interrogate “suspicious lesions?”

We’ve covered this in another blog on melanoma, but the ABCDs are important for diagnosing precancerous or cancers lesions.

A — Asymmetry: Does half of the lesion look different from the other half?

B — Border irregularity: Are the edges of the lesion uneven, ragged, or blurred?

C — Color: Does the lesion have a variety of colors?

D — Diameter: With is the size of the lesion?

Removing suspicious lesions

If Dr. Carter is wary of a particular lesion, she will excise it along with 2mm of healthy tissue surrounding it. This tissue will then be biopsied.

Do you have a suspicious skin lesion? Don’t call Harry Bosch; call Dr. Carter at [primary_phone].