Case discussion: How would you treat this patient? [3 July]

This week we have a straight forward case discussion from Dr Colin Armstrong. Everyone will likely know this diagnosis but please list the specific criteria that confirm the diagnosis dermoscopically.

Case discussion_Colin     Case discussion_Colin

Case discussion_Colin     Case discussion_Colin

Update:

What are the treatment options here, and what would you do, and why?

Please share your thoughts in the comment section below. Professor David Wilkinson will provide his opinion and advice.


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8 comments on “Case discussion: How would you treat this patient? [3 July]

  1. pigmented BCC
    pearly colour, asymetrical, arborising blood vessels, fleck of pigment
    for excisional biopsy 2mm margin

  2. Black dots, blue globules, arborising vessels with pink background on a chaotic lesion along with some white lines and dermoscopic grey consistent with Pigmented BCC

  3. Yes I agree pigmented BCC, but I always have a dose of reservation to possibility of melanoma ( hidden) and I ask for second opinion and review just to be sure that WE do not miss melanoma, as 2 and 3 o’clock areas has grey pigmentation as well which is possibly deeper part of melanoma. I would express concern to pathologist at time of sending sample about that zone , so he can perform extra cuts.

  4. chaotic lesion with pigment, arborising vessels and blue clod. this is a pigmented BCC and requires excision which I would do with a 5mm margin. It appears to be on a limb, small and allow a simple elliptical excision and closure.

  5. Clinically: a slightly raised erythema mixed with black dot over left flank.
    Dermoscopically:
    Arborising vessels with blue clod (3-4′ o clock) suggesting BCC. In view of a few brown pigmentation and dots, pBCC can be named. However there are subtle other pattern of v/s (5 & 9′ o clock + scaly): D/Dx- AK or SCC or SK.
    In term of management, punched biopsy would be reasonable at first instance and go from there. Not sure why others quickly jumped into 2 or 5mm margin excision w/out strong C&C for MM.

  6. thanks to all for comments. this is a great case – this is a pigmented BCC; arborising blood vessels and blue / grey clods seal the deal here. there really is no other differential. When you are confident with dermoscopy, going straight to treatment is sensible and I would recommend a 3mm excision here. You could also do curette and cautery – because this type of nodular BCC is not aggressive and the margins are very clear.