Case discussion: How would you treat this patient? [24 September]

This week we have an interesting case from Dr Slavko Doslo. A man was concerned about a spot on the back of his arm. A full body skin check was suggested and the patient agreed to it. During the check, the Dr noticed something more interesting on the patient’s skin. 

What do you make of the clinical images and why might you choose to magnify these images?

Case discussion     Case discussion

Case discussion     Case discussion

Update 1:

Below are the dermoscopic images in the same order as the above clinical images. What is your observation and what would you do next?

Case discussion     Case discussion

Case discussion     Case discussion

Update 2:

Below are the Pathology reports in the same order as the above clinical images. What are your next steps?

Upper back:

Case discussion   Case discussion

Left arm:

Case discussion

Lower back:

Case discussion

Lateral chest:

Case discussion     Case discussion

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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10 comments on “Case discussion: How would you treat this patient? [24 September]

  1. Top one looks like actinic keratosis, neavus,
    2md one is more interesting, probably a solar keratosis or bowen’s disease/scc
    3rd one is the most interesting, is nodular pigmented , definitely needs Dermoscopy.
    4th one looks a small neavus no different to background

  2. I tried to spice a bit this site.
    As we all know , something has to get to our attention on skin to use dermoscope on that lesion.
    Otherwise we would spend hours examining all spots. So in this case I wold like you to see is anything at all interesting , or something to attract you attention to look any of those spots. At this stage is not question to answer is it this that or that.
    For this case task would be, would we put dermoscope on any of those lesions or we would just skip looking them closely.
    Dr Slavko Doslo

  3. 1Asymmetry of colour and structure.Clue is bluish area.
    Suggest excision biopsy
    2 Keratin plug, biopsy, is either solar keratosis or Scc.

    3: Pigmented lesion
    No chaos, no clues, reticular pattern, benign neavus

    4: Asymmetric lesion in structure
    Eccentric structureless area.
    Needs a shave biopsy

  4. All 4 lesions potential skin cancer
    *Lesion 1/ flat pigmented lesion, and in a way a bit similar to lesion 4 – consider comparing to other pigmented lesions in the area and if more similar lesions one could decide on either short term digital monitoring – if this is not available I`d do a shave biopsy for both lesions.
    *Lesion 2/pink and raised + keratin – likely a well differentiated SCC – needs a biopsy to confirm this – punch biopsy would be an option but since we have 2 other flat pigmented lesions to biopsy as well, we might just do shaves on all 3.
    *Lesion 3/ pigmented and possibly a bit raised – excisional biopsy with 2mm margins
    *Lesion 4/ same as discussed in lesion 1
    Also consider Total Body photographic monitoring.

  5. lesion 1 – polygons and dermoscopic grey- possible lentigo maligna. needs excision

    lesion 2- grade 3 actinic keratosis, apply cryo 2 weekly

    lesion 3- mild junctional nevi, leave it alone

    lesion 4 – mildly dysplastic nevi, leave it alone