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.

Microscopic:
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

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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 .!
    Thanks