Case discussion: How would you treat this patient? [27 May]

This week we have an interesting case from Dr Tracey Zeelie. We don’t have a history or clinical picture.

What is your opinion on this dermoscopy image? If you would biopsy, what technique would you use?

Case discussion

Case submitted by Dr Tracey Zeelie

Update:

Here is the pathology result. What would you do next?

DIAGNOSIS – SQUAMOUS CELL CARCINOMA IN SITU

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9 comments on “Case discussion: How would you treat this patient? [27 May]

  1. dots in linear arrangement of black dots on a brown structureless background suggest bowens or SCC in situ, can use aldara to treat this and reasses in a month

  2. It’s an asymmetric lesion, and with the diagnoses of melanoma and pigmented Bowen’s disease in mind, an excisional biopsy should be taken.

  3. Nice pinky pigmenetd picture.

    Dermoscopically: Chaotic (asymmetric and >1colour). Clues: central structureless area (regression) with mild scales in the background of pink erythema mixing with pigment. Interestingly radial streaming of pigmentation toward peripheral with scattered pigmented dots (markedly Left hand side). Thus, raised possibility of MM and NMSC (eg, pSCC or pIEC).

    Biopsy: Ideally 2mm margin excisional biopsy as MM cannot be entirely ruled out. However deep-shaved method can also be considered in sensitive areas such as face and others by weighing how much possibility of MM. I am a bit inclined on NMSC (pIEC or pSCC) due to lack of other clues for MM, and this is also associated with scales. Further step- Go from biopsy report.

  4. Pigmented Nevus with central pink, polymorphic vessels and white lines suggesting regression. Disruption of peripheral pigment pattern with asymmetry. Darker thicker lines between 6 to 10 O clock position suggesting Irregular peripheral growth and Pseudopods. High Grade Dysplastic Nevus vs Melanoma in Situ. I would choose a 2mm margin Excision Biopsy

  5. Pigmented SCC in situ most likely . Could treat w Efudix and review in 3months. Either do punch first to confirm.

  6. First look is pigmented BCC – leaf-like pigmented areas and fuzzy streaks on periphery, brown dots.

    But coiled vessels in cental white desmoplastic area with thin white scales tend this lesion to be a SCC.

    It may be a fusion – basosquamous carcinoma.

    Excision with 4 mm margins