All of the above are important elements of the history in this lady.
I would like to ask her about when she first noticed the lesion and what
the circumstances where. I would ask her about bleeding, itching and pain and
the rate of progression in the size of the lesion. Has she noticed any other
similar lesions elsewhere.
What treatment has she received for this lesion to date?
I would ask her about previous illness and in particular about previous
operations for neoplastic processes. Is she on any drugs or has she any
allergies?
Trauma is an important question. However, a history of trauma prior to the
patient first noticing the lesion does not mean that the lesion is traumatic
(even though the patient will not be likely to agree with you). In addition
this part of the body is relatively protected from trauma, the antero-lateral
aspect or anterior shin is more likely to be injured. Trauma may
bring the lesion to the patients attention for the first time. If there has
been an injury then the patient may develop a pyogenic granuloma due to
exuberant healing. This lesion looks too large for a pyogenic granuloma
though.
Previous surgery is important for many reasons, there may have been a
problem with anaesthesia which would be important to know. The patient may have
recurrence of a previous problem, for example re-growth of a sarcoma. The
patient may have a cutaneous metastases from a tumour resected from another
location. The patient may have a sinus from a previous osteo-myelitis (again
more likely over the anterior aspect of the tibia).
A history of deep venous thrombosis is relevant. The patient has some
signs of venous insufficiency and this may be affecting her healing. Many
patients presenting with chronic venous insufficiency due to previous deep
venous thrombosis do not recall any episodes of thrombosis, remember to ask
about swelling and pain in the leg after prolonged bed rest or during
pregnancy, also ask if the patient had to have the legs bandaged for swelling
post partum, ask for a history of major surgery or lower limb fractures. If
the patient has had a recent deep venous thrombosis they may have a
thrombophilia as a paraneoplastic manifestation of the
underlying malignancy that has not been detected yet.
A history of drugs and allergies is important.
