Case discussion: How would you treat this patient? [6 July]

In this week’s discussion, we have an interesting case from Dr David Stewart, which features:

  • 50 year-old female patient
  • Undergoing chemotherapy for bowel cancer
  • Lesion at her hairline

Please review below images. What is your assessment?

Case discussion      Case discussion

Update:

Here is the pathology. What next?

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.

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19 comments on “Case discussion: How would you treat this patient? [6 July]

  1. An odd appearance, the two images don’t seem to match. Pink, pearly, raised with a keratin plug. I am not confident to excise with a 3 mm margin, so I would punch biopsy this, at the risk of it being an amelanotic melanoma . I get nervous with a shave. I guess both are not ideal with a melanoma , is one considered better here.? Thanks

    1. It can be anything from primary skin cancer like BCC/SCC/KA/Melanoma or secondary metastasis from bowel cancer or cutaneous side effect from chemotherapy. I will prefer to do excisional biopsy so the dermatopathologist can get the most information for interpretation. (esp. differentiate KA from SCC)

  2. extra level of concern in someone receiving chemotherapy, increased risk SCC; macro shows a pink lump with central ulcer and dermoscopy doesn’t show much more – structureless pale pink periphery with loss of hair, central orange with a little scale and a few vessels; I would do a 4mm punch biopsy for diagnosis

  3. Pictures are low quality. Pink nodule with central keratin plug may be a KA.
    According to history it may also be a some metastatic eroded nodule.

  4. The 55-year-old lady on chemotherapy and bowel cancer, scalp lesion elevated, central ulceration, hyperkeratotic and irregular margin are highly suspicious of SCC, I prefer to do excision biopsy with 2 mm margin

  5. 55yo female.
    Increased risk with chemotherapy.
    Lesion is not typical.
    Punch biopsy.
    Could easily remove and hide scar in hairline.

  6. Agree with most comments, pt on chemo, on hairline, no vessels DD WILL BE BENIGN GROWTH OR SCC
    it needs to be excised as cosmetically wont be excepted by the patient, so I would excised with 3mm margin

  7. Pink raised lesion with central orange scab suggesting an underlying ulcer. No particular dermoscopic clues detected so a very broad DD – BCC/MM/metastasis/KA. SCC may be the most likely diagnosis but I would do a 4mm PBx and get histology info before deciding on further management.

  8. Interesting case, right? Not everything is a skin cancer! Sadly, a metastasis. “if any doubt – cut it out”. This could be 1 of a long list of benign and suspicious lesions – so it MUST have pathology. A nice, large (4 or 5mm) punch will give the answer.