Case discussion: How would you treat this patient? [18 April]
Brian, 82 year old retired accountant presents for routine skin exam. No lesion of patient concern. Only had recreational sun exposure or when boating. Unremarkable dermatological and family history. Scattered seb Ks and solar damaged skin over upper back. One lesion on upper left trapezius was noted to be flat and irregular in pigment pattern compared to scattered seb K’s.
Do you see any suspicious lesion?
Now do you see any suspicious lesion?
Does the Dermoscopy image help you at all?
How would you biopsy this lesion? Why?
This image shows the shaved site after bleeding arrested with Monsel’s solution (Ferric Subsulphate) Broad deep shave. Opsite dressing applied for 3 days.
Clinical Notes: Shave biopsy Left T2 – excl ?MMis.
Left T2: The specimen consists of an irregularly shaped portion of skin measuring 21x15x1mm. Examination of the skin surface reveals a discoloured scaly roughened patch measuring 13x9mm. Blocking Details: 3ts A, 4ts B.
Sections show pityriasis versicolor with an overgrowth of pityriasiform yeast, hyphal and yeast forms, within the keratin layer. There is otherwise focal mild basal pigmentation (solar lentigo-like), a focal small junctional lentiginous naevus with no significant atypia and focal excoriation.
SKIN SHAVE, LEFT T2: – PITYRIASIS VERSICOLOR.
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