Case discussion: How would you treat this patient? [30 September]

This week we have an engaging case from Dr Armstrong. A pink lesion was found on a patient’s right arm during a routine skin exam. The patient was unaware of the lesion.

Clinical image: Flat pink area – non-tender, no history of ulceration or bleeding.

Dermoscopic image: Ill-defined pink zone with arborising vessels- has an almost ‘waxy’ appearance. Polarising specific white lines and white circles.

Dots at edge of dermoscopic limits of lesion. Solid line shows margins applied with 4-5mm as this pattern is often seen in infiltrative BCC subtypes and edge is poorly defined.

Mark ellipse with patient sitting upright with arm in relaxed or neutral position.

The sections of skin include deep subcutis. There is a superficially invasive infiltrative and partly sclerosing basal cell carcinoma. It invades to the level of the upper/mid reticular dermis. No perineural invasion is identified. It appears clear of the excision margins by at least 2 mm to the closest peripheral edge which is to 9 o’clock. The deep margin is well clear.

Closed wound- used 3/0 Monosyn for buried sutures and continuous skin suture.

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.


Learn more about skin cancer medicine in primary care at the next Skin Cancer Certificate Courses:

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One comment on “Case discussion: How would you treat this patient? [30 September]

  1. Thanks for this case, the method of planning and excision are very helpful.
    I notice you close with a ? Monosyn running suture . Did you use deep sutures as well and does this final suture need to be removed . I usually close with Nylon, but with small jobs I have way too much Monosyn left over? It’s has a very long thread .!