Case discussion: How would you treat this patient? [2 July]

This week we have an interesting case from Dr Tim Aung. An 40-year-old male presented for a skin check and a lesion was noted.

What is your evaluation of the clinical and dermoscopic images? What would you do next?

Case discussion     Case discussion

Case discussion      Case discussion

Update:

These are the results from the pathology report. What is your conclusion and what are the next steps you would take to treat this patient?

Case Discussion

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11 comments on “Case discussion: How would you treat this patient? [2 July]

  1. its very non specific, no changes to comment. given the young age and presentation it is most likely a follicular cystic eruption, leave it alone

  2. It is pink and raised, structureless with serpiginous and arborising vessels. It deserves a biopsy, shave or punch, as I believe it looks like a BCC (even though it is probably a cyst – the title of the picture when you click on it `gives it away`- spoiler alert) . I`ve found BCCs before in 40 yr olds in northern NSW area.

  3. A pink lesion with white on a background of pigmented skin from sun damage. 2 white circles.
    Excision biopsy of the whole lesion.

  4. First impression;
    Pale with border ? porokeratosis
    Second impression
    Pink
    Vessels out of focus
    One white spot at 1O’clock – Biopsy
    (?SCC)

    1. you only get the 30071. nothing more, the day patient comes back for results you claim AFTERCARE. honestly the medicare system is BS for GPs hardwork

  5. Amelanotic melanomas usually arise in people over 65, 40 is too young. but always golden rule, when in doubt-biopsy!

  6. nice case from Tim. Not everything is a skin cancer! If you are unsure – as Ashwin says, biopsy. If, clinically, you are confident it is a cyst, leave it.

  7. Erythematous structurless lesion with superficial small ulceration
    blood vessels pattern is not clear
    Thin basal epidermal layer at the base
    inflammatory lesion
    no hair follicle seen but still can be a ruptured follicular cyst

  8. It was a lonely and outstanding at whole body skin check w/out any follicular or other types of skin lesions. V/s pattern was non-specific but raised, milky-pink with mixed v/s inside (?polymorph) cannot rule out aMM, BCC and alike. Thus, a punch or 2mm excisional biopsy> peace of mind.

    Re. age for aMM: any age. Of course, median age 50-60 with ^^^ with older age. Ref:
    1/ aged 22-86 (median 54) at 46 cases (Red, Raised, Recent change); https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465919/
    2/ aged 24-86 (median 56) at 18 cases; https://www.ncbi.nlm.nih.gov/pubmed/2214928

  9. My first amelanotic melanoma was disgnosed in a 25yr old female. Hence while there are statistical probabilities related to age it is prudent not to use as part of the diagnostic criteria!
    This lesion could probably have been monitored very short term.