Case discussion: How would you treat this patient? [16 April]

This week we have an interesting case from Dr Nameer Wadea. An 34-year-old male, uses sun bed frequently and had developed two small lesions on the left side of the face – injures them when he shaves. Dr Wadea asks “your opinion regarding liquid nitrogen vs excisional biopsy – as cosmetic concern is important”

Please review and describe your evaluation, and proposed next step/s?

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Case submitted by Dr Nameer Wadea

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7 comments on “Case discussion: How would you treat this patient? [16 April]

  1. Non specific lesions with non specific dermoscopy. i wonder if this is non contact mode ?
    can be a sebaceous hyperplasia which has been shaved and damaged
    can try shave biopsy to remove them for histopath analysis given the history of Intense UV exposure to rule out indolent BCC as a D/D

  2. These branching blood vessels are thicker than what I normally see in BCC.
    It is rather unusual lesion. Shave excision and cautery will help to get histological diagnosis and less scaring seeing that the lesions are small.

  3. I am wondering about a traumatised dermal nevus? I think it is benign, but I would also do a shave biopsy

    1. Thanks for your response, I biopsied the first one, but I used liquid nitrogen for the second one.. histopath is still pending, because I wanted to exclude bcc

  4. The lesion appears raised and is highly vascularised so biopsy seems preferably. Could be BCC but could be poor diff SCC – cryo would not be 1st choice either way.
    If this is an invasive skin cancer and you want to `freeze it`long enough to be effective you`ll likely end up with a significant pale scar which seems to be an issue for this patient.
    I would do a rather superficial shave biopsy as it tends to heal without too much scarring.

    What was the histopath result