Case discussion: How would you treat this patient? [11 May]

In this week’s interesting case from Dr David Stewart, we have the following patient:

  • 50 year-old male smoker
  • Non healing ulcer on lip

Please review the below images. What would you do next?

Case discussion      Case discussion

Update:

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

Case discussion

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18 comments on “Case discussion: How would you treat this patient? [11 May]

  1. This lesion on the lip shows dermoscopic evidence of serpentine vessels suggesting BCC. This is unusual in the lip but sometimes,it may occur together with SCC which is more common at that site
    My next line of management is to take a punch biopsy .
    My reasoning is to let but ultimate management is wedge
    excision and proper alignment of the vermillion border.

  2. Looks malignant to me (DDx SCC, BCC, amelanotic melanoma), ie would not bother with punch Bx first.
    Wedge excision taking care of proper alignment of the vermillion border. Would discuss w/ colleague & probably refer him on for this given position of lesion.

  3. Non pigmented skin lesion with serpentine blood vessels and an ulcer Diagnosis BCC differential poorly differentiated SCC. management Punch or shave biopsy followed by wedge excision

  4. This is clearly a malignant skin lesion involving lip . I would refer straight to a plastic surgeon for thsi reason to get good cosemetic result and complete excision.

  5. Malignant lesion. No pigment. Yellow crust. Maybe some white circles. Clear in focus branching serpentine vessels. HIstory favors SCC but can be BCC or Melanoma. Attempt at removal – if technically too difficult biopsy first and refer.

  6. clear historical risk factors favor SCC,. needs a biopsy and wedge resection if confirmed malignant

  7. Arborising blood vessels duggestive of BCC. Punch biopsy to confirm diagnosis and plan surgery (3mm margin if BCC). Referral to plastic surgeon for wedge resection.

  8. looks like scc,I would do shave biopsy to confrim the diagnosis before excision.

  9. clinical: nodular lesion upper, inner canthus lip, rolled edges, keratin centre
    dermoscopy: arborisong vessels peripheral
    DDx: BCC, SCC,

  10. Raised ulcerated lesion with white structureless areas and serpentine vessels ; A malignant lesion requiring wedge excision ; Most likely SCC in 50 YO smoker and site of lesion .

  11. Simple, instructive case. Punch biopsy to establish diagnosis, followed by excision and repair (probably a wedge). These bleed a lot, but they health very well.