1300 856 695
+44 203 514 0688
1800 867 1390Case 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?
Update:
Here is the pathology. What next?
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:
1300 856 695
+44 203 514 0688
1800 867 1390
Can this be a SCC or even amelanotic melanoma?
Would do a shave biopsy to confirm.
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
?SCC? amelanotic MM
I would perform multiple punch biopsies
pink nodule new , with linear vessels , may be amelanotic melanoma, Needs biopsy
polymorphic vessels
pseudopods
? BCC
excision biopsy
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)
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
any new lesion in pt on chemo I would Bx. The scalp is relatively easy to do an excision Bx
Needs a biopsy. SCC
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.
Drug induced eruption of chemotherapy, would need a 3MM punch biopsy to exclude SCC
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
d/d
-SCC
-Amelanotic melanoma
-Keratoacanthoms
-Secondaries
I will do 4mm punch biopsy
KA and I would excise with 2 mm margin
55yo female.
Increased risk with chemotherapy.
Lesion is not typical.
Punch biopsy.
Could easily remove and hide scar in hairline.
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
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.
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.
Thanks for the case David.