Keratinised nodules

These cases serve to remind clinicians of the particular features that help when discriminating SCC and KA from other malignant and benign papulonodules such as amelanotic nodular melanoma, nodular BCC and irritated seborrhoeic keratoses. The most useful discriminating features in the diagnosis of SCC and KA are signs of keratinisation, including central hyperkeratosis, white structureless areas and white halos and circles. Vascular features also aid diagnosis, with glomerular, hairpin and serpentine vessels being the most frequently seen. As always, dermoscopy, coupled with the history and gross morphology, aids the decision-making process.