Case discussion: How would you treat this patient? [15 January]

This week we have an engaging case from Dr Tim Aung. A 40-year-old female with concerns about a lesion presented for months. 

Please review and describe the clinical and dermoscopic images. What is your evaluation, and differential diagnosis? What would you do?

Case discussion Tim aung      Case discussion Tim Aung

Case discussion Tim Aung     Case discussion Tim Aung

Update:

Here are the results of Dr Tim Aung’s punch biopsy. What is your conclusion and what are the next steps you would take to treat this patient?

Case discussion Tim Aung    Case discussion Tim Aung

Comment from Dr Tim Aung:

The histopathology report haemangioma is consistent with dermoscopic clusters (islands) of violet reddish v/s separated by white tissue. The reason for unclear v/s is probably too much fibrous squeeze or dermoscope plate pressure. I don’t know why it had so much keratosis/fibrosis. I felt that angiokeratoma can be used here due to very prominent keratosis in this case. Angioma is an umbrella term for either haemangioma or lymphangioma.

Dermatofibroma (DF) can be one of the differential diagnoses here, but its clinical/macro smooth dome-shaped nodule and dermoscopically-central white (scar like) area with peripheral  network (depending upon use of PL or NPL). The reason directing biopsy was to rule out nBCC and rare sinister aMM. Haemangioma did not cross my mind before biopsy.

Photo reference: Atlas of Dermoscopy, 2012, 2nd ed.,  by  A A Marghoob, J Malvehy, R P Braun).

We encourage you to participate in the case discussions and submit your own clinical images and questions so we can all learn together.

 

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9 comments on “Case discussion: How would you treat this patient? [15 January]

  1. Likely a variant type of dermatofibroma I would say – but I`m only a beginner in dermoscopy.
    If this lesion been present since a few months only and consequently growing rather quickly I would probably biopsy it with a 6mm punch.

  2. This is a Dermatofibroma, there are several subtypes to it. There are no cancerous features here. i can definitely say that it looks if you were to check it by pinching the skin, the dimpling appearance on top will confirm the suspicion of the same. Reassure the patient, no biopsy needed

  3. great case from Tim – thanks Tim! for me, thinking goes like this: 1) I don’t know what it is (I can’t name it, for sure), 2) so I must biopsy it. It is pink / not pigmented so a pinch biopsy at least 3mm but I would do 5-6mm (why not – the more tissue the better), then I would decided on final treatment. This does not really look like a DF, though I agree it is in the differential. surprising result, but good news

  4. great case, caught me by surprise ! this is why i always rely on pathology as gold standard ! Dermoscopy is only 90% correct

  5. This is a benighn , simmetrical in shape and color , withoud any obvious network or wheil lesion

    The best diagnosis is punch biopsy as a possible malignancy in situe –BSS or SCC are still possible Regards
    DR Lucy Zvedeniouk