Case discussion: How would you treat this patient? [18 December]

This week, we have a truly unique case from Dr Slavko Doslo. A 63-year-old male with lesion noted in the eye. The patient thought it was due to his wood turning hobby.

What is your assessment of the clinical images? What would you do – if anything?

Case discussion _Slavko Doslo     Slavko Doslo _ Case discussion

Update:

This is the pathology result. What is your conclusion and what are the next steps you would take to treat this patient?

Case discussion - Slavko Doslo

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10 comments on “Case discussion: How would you treat this patient? [18 December]

  1. I think this is a pterygium in the medial canthus of the patients right eye,as it appears to be just beginning to encroach across the limbus towards the pupil.The vascularity and elevated,fleshy nature of the lesion support this diagnosis.Pingueculum is another possibility,but these are usually lateral and don’t grow across the limbus towards the pupil.
    The only eye cancers that I can think of are melanomas of the iris and choroid.
    Re pterygium,I would continue to observe and if the lesion became more irritable or grew rapidly more medial, I would refer to an ophthalmologist with a view to excision and superficial radiotherapy.

  2. Pterygium encroaching onto the cornea. I have never heard of BCC in the eye. The only other DD is if this is an amelanotic melanoma which can only be confirmed on a shave biopsy

  3. Not sure where the lesion is pointed to and certainly warrants assessed by Ophthalmologist/Optometrist. ??rare case of MM from retina or nearby. Nevertheless abnormalities noted are:
    1/ Serpentine and leaf-like branched v/s with thick/dilated (Pterygium encroaching onto the cornea)
    2/ 2x brown pigmented spots- 12’o and 6’o clock of Cornea (not sure how significant).
    3/ blue-grayish medial border of cornea, again that can be argued with due to angle of camera and light reflection.

  4. Slavko – do you want to comment on what made you suspicious here, and what you did? It is an amazing case! David

    1. Thanks for Q, but I like to watch and observe every patients move and posture from the time when I call patient into my room . I am not afraid to ask questions. And I like to call myself ” Dr Why” because I am always asking ” why” for any symptoms. The same was in this case of patient who I was seeing for while. I knew that he was doing wood turning , and we see a lot of pterygiums , but I like to look. So I asked if I can look as ” something ” was not right in my mind ( sixth sense) . Took photo showed to patient and express my concern as something was telling me this is not right. Local optometrist did further photos and we referred to specialist who had doubt that is sinister but he followed his instincts and operated on him. So I will not be new Jedi , but after last comment I might give myself nickname as Jedi as JC made me laugh to tears. My patient was extremely happy with outcome.
      Thanks SD

      1. In addition ,there were too many vessels and too many branchings of them with strange endings like frog fingers that I never saw in any pterygium , and simply too much blood supply for something benign, I am glad ,lucky and happy that I looked closely

  5. My differential DS is pterygium ,episcleritis , scleritis
    we do not know enything about the patiend history ? CTD or any other personal or family history
    Extreemly tare possibility NON-melanotis melanoma of yjr choroid