Case discussion: How would you treat this patient? [18 May]

In this week’s case from Dr Silke Vahar-Matiar, we have a:

  • 40 year-old male patient
  • First skin check

How do you evaluate these images? What would you do next?

Case discussion      Case discussion

Update:

Here is the path report – what would you do next?

Case discussion

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

    1. I’d probably excision biopsy with 2mm margin. Indistinct border towards the measurement scale so if in doubt err on a larger margin there.

    2. Agree, treat as possible melanoma but may be pigmented BCC, as it is a pigmented lesion with apparently 2-3/3 features. on sun damaged skin . history of the lesion might be helpful too.

  1. Chaos for colour and pattern with clues
    Suspicious pigmented lesions 2mm margin excision biopsy

  2. Irregular border, structureless area; clods; thick black lines; peripheral radial lines – BCC. Needing at least 3mm clearance.

  3. A chaotic lesion with an eccentric pigmented blotch, pigmented streaks, multiple colors including gray, blue, pink and brown, white thick lines, linear irregular vessels, scattered gray and brown dots. Most likely BCC, but melanoma is also in differential. Excisional biopsy.

  4. Look like BCC but pigment portion is there if dermoscpy picture is available would better clarification
    Next step is safe to do Excisional biopsy with mm margin

  5. I would score it 3/3 on the checklist
    which would mean excisional biopsy with 2mm margins
    ?melanoma

  6. A blink diagnosis of melanoma. DD could be with BCC but I think I see some remnant reticular network at 9 o’clock, so that rules that out!(?) Black blotch and chrysalis lines suggest a thicker lesion – excisional biopsy of the whole lesion +2mm margin is recommended.

  7. quality of the dermoscopic non contact picture is quite bad to be honest, a diagnosis is not possible with this dermoscopy and unless if a medium such as alcohol gel is used to get a clearer image. Looks like a pigmented BCC with some spokewheels visible in periphery. will need excisional biopsy done 2mm margins to get an idea

  8. Asymmetrical pigmented lesion with some white lines, dot pigmentation, some arborising telangiectasia.
    Differential diagnosis – 1st Pigmented BCC and 2nd melanoma.
    I’ll do my 2mm excision biopsy

  9. Chaos in colour with asymmetrical distribution of pink, brown, and grey area and blue-white veil. Polarised white lines +ve, an island of a grey ovoid nest at 8’clock position and arguably at 5 and 6 oçlock position. Few irregular pigmented dots present
    ? Pigmented BCC? Melanoma
    Plan- Excision biopsy with 2 mm margins

  10. irregular chaotic lesion, dark pigmented lesion with thick reticulum with blue white veil on the background of homogenous pink pigmented lesion. Excision biopsy with 2 mm margin to rule out melanoma

  11. Chaos of color and structure. Black dots and black blue clods. Excision biopsy – 2mm margin. Re excise based on path results.

  12. This ERYTHEMA background mixed with pigmented portion can be (1) pBCC, (2) MM (SSM), (3) pIEC/Bowenoid. 2-3 mm margin EXCISIONAL is an ideal biopsy as punched biopsy should not be applied for suspicious pigmented lesion (ie. if MM is suspected). Go from HP report for next step.

  13. Thanks everyone. Suspicious PSL = 2mm excision biopsy. Melanoma confirmed, and now needs wide excision, with margins defined by Breslow thickness