Case discussion: How would you treat this patient? [4 February]

This week we have an engaging case. What do you make of the clinical and dermoscopic images below?

Is there a differential diagnosis? If so, how would you biopsy?

Case discussion

Update:

These are the results from the pathology report. What are the pros and cons of the treatment options here?

PATHOLOGY RESULT:
Pathology report unable to be found.
This was a pigmented BCC.

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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6 comments on “Case discussion: How would you treat this patient? [4 February]

  1. Pigmented BCC most likely. DD hypopigmented melanoma.
    I only see the dermoscopic pictures, not the clinical, so not sure about the size of the lesion, I suspect it is relatively small. I suppose full excision with narrow margins would be the safest approach.
    Cannot see other bloggers `s comments either – ?change in the layout of the blog maybe.

  2. Chaotic lesion.
    Focal pigmented lines.

    PSK, sBCC or pigment actin keratosis.

    Shave or excise with 2 mm margin.

  3. looks like a pigmented BCC with leaf like and spoke wheel appearance, needs shave done for confirmation. Not suggestive of a melanoma even though its peripheral island of growth

  4. Clinically: Unable to comment, due to lack of relevant history such as macro photo, site, size and duration,.. .
    Dermoscopically: Erythema leaf like fanning out with few scale. Blue clods L hand top consistent with BCC (pBCC). If so, 3-5mm punched biopsy (depending upon size of lesion) and go from there.

    Nevertheless, how confident to r/o MM in the context of L hand top blue clod + adjacent (peripheral) black clods (melanin proliferation)?? If so, 2mm margin excisional is also an option and go from there. Certainly Chaos and Clues present.

  5. Thanks everyone. This is one of those case where if you know your dermoscopy (well) you know (for sure) that this is a pBCC. My view – as you know – is to always biopsy a suspicious lesion even when I am confident on dermscopy, so I would do a punch biopsy here (based on my vvv high dermoscopy confidence). And then, I would excise.