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1800 867 1390Case discussion: How would you treat this patient? [12 March]
This week we have an interesting case from Dr David Stewart. An 52-year-old male, renal transplant patient presents with a lesion on his Right ear.
Please review and describe the clinical and dermoscopic image. What is your evaluation, and proposed next step/s?
Update:
This is the pathology result. What is your conclusion and what are the next steps you would take to treat this patient?
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1300 856 695
+44 203 514 0688
1800 867 1390
Dermoscopy won`t tell us what it is really – my best guess would be that this is a poorly differentiated SCC on a background of AK, but might as well be a metastasis, amelanotic melanoma, pyogenic granuloma …
I think I would do a shave biopsy taking the entire (superficial part of the) lesion to determine further management.
And do a physical exam of his lymph node stations.
Red raised vascular lesion not typical of angioma and with indistinct polymorphic vessels. Dermoscopt not diagnostic here. Skin in vicinity shows actinic damage. Differential here would be poorly differentiated SCC, Merkles cell carcinoma, amelanotic melanoma, pyogenic granuloma and possibly AFX
It requires excision biopsy of lesion in first instance
Since he’s on immunosuppressant, which predispose to Ca, excision biopsy and LN check
Lesion is regular , but at 12 O’clock there is a purple hue.
History is important .He is immuno suppressed.
A few punch biopsies ie one of the lesion, one of the purple hue and one of the surrounding area.My guess is Kaposi’s sarcoma
Poorly differentiated SCC is the major D/D here given the history of immunosuppresion and dermoscopy. Will need a shave biopsy
Pilomatrixoma is unheard of on the ear. Dermoscopy and histopath are not matching, get a re evaluation done
The patient has a regular dermatologist and only saw me to see whether “this thing on the ear” could wait until his next dermatology review the following month. Somewhat frustratingly despite me forwarding the pathology report and a couple of emails, the dermatologist letter from the subsequent visit made no mention of the lesion on the ear!
I’m still chasing it up and will post here if there are any developments
The lesson for me in this case, is that not everything is a BCC or an SCC! Biopsy and excision will do the trick.
This is a well demaekatwd , round , bright red , firm , red lesiob ob the sun exposed area
The vessel atypia suggests nodular SCC
But amelanotic , nodular melanoma , which is very aggressive and dangerous can not be excluded .
An excisiobal biopcy with 2 mm margin is important urgently , then depending on the histopathology [ if nodular melanoma will be confirmrd] a complete local excision and ventinel nod biopsy will be the next step.