Case discussion: How would you treat this patient? [22 October]

This week we have an interesting case from Dr Dave Stewart. A 63-year-old female firm, growing nodule, upper arm.

How would you describe the clinical and dermoscopy cases? How would you biopsy? What is the differential?

Case discussion    Case discussion

Case submitted by Dr Dave Stewart

Update:

Here are the results from the pathology report. What is your conclusion and how would you treat this lesion?

Case discussion

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10 comments on “Case discussion: How would you treat this patient? [22 October]

  1. Central structureless area.
    Peripheral blood vessels.
    Suggest excision biopsy

    Keratoackanthoma or Dermatofibroma

  2. Firm red and growing. excision biopsy .Dermoscopy well defined colourless pale with peripheral vessels. Dermatofibroma , granuloma ,amm

  3. Macroscopic appearance is an uncreated exophytic growth.
    The pressure of the dermatoscope has obliterated the vascular pattern. But it looks ulcerative with an impression of some white circles.
    I would excise this completely to look for AK, KC or SCC.

  4. eccentric structureless area
    polymorphic vessels
    few light brown polygons upper zone
    Most likely diagnosis is dermatofibroma but need to exclude an amelanotic melanoma due to the history of a growing nodule

  5. management : EFG rule: elevated firm and growing = excise
    elevated lesion with central structure less ? erosion (yellow scale) and peripheral polymorphous vessels
    DDx: Keratoacanthoma, SCC, AMM, dermatofibroma.

  6. do a sentinel node biopsy where it is draning to along with referral to plastics for wide local excision and urgent referral for radiotherapy as its the most aggresive cancer on the planet, great case

  7. Just for everone’s info, I referred this lady to a local dermatologist who removed the lesion with 1cm margins and wrote “I have explained the basic approach to managing Merkel cell tumours with (the patient), including wide excision, followed by radiotherapy to the draining lymph nodes, a wide field surrounding the excision site, and possibly also radiotherapy of the the in-transit lymphatics, if such a procedure is possible.”
    Also, dermoscopy image is a bit misleading – non contact dermoscopy showed a very vascular nodule, but with pressure it gave the image shown. Unfortunately I couldn’t get a decent photo with non contact 🙁
    Thanks everyone for the feedback