Case discussion: How would you treat this patient? [27 July]

In this week’s case from Dr Raghu Vasanthan, his patient noted a possible change in their lesion since their last skin check three months ago. Located on their back, it had previously been stable for the last 10+ years. Further details:

  • 68 year-old female patient
  • History of multiple BCC’s
  • No symptoms

What is your assessment, and what would you do next?

Once you have made your assessment, scroll further for the pathology report!

Case discussion

Case discussion      Case discussion

Here is the pathology report. What now?

Case discussion

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8 comments on “Case discussion: How would you treat this patient? [27 July]

  1. Dermoscopy definitely showed NMSC features including aborizing blood vessels, white crystalline structures, amorphous milky pink colouration, internal assymetry. So sling with reported change excision was necessary.

    Dermet says that no other treatment is necessary the margins seem adequate.

  2. 68 yr old, lesion on back. changing.
    exception rule in an adult patient. therefore , need excision.

    clinically, soft pink lesion on back
    dermoscopically: structure less, milky pink with branching vessels, polarized white lines, superficial ulceration and microfibre sign.
    clinical diagnosis: BCC ( fibroepithelima of pinkus)
    DD: melanoma
    plan: excision biopsy

    based on histology: adequate excision:

  3. Dermoscopy features consistent with BCC – white lines, arborising vessels, ulceration, white veil. 3mm excision seems adequate. For follow up general skin checks and new lesions. Check for lymphadenopathy.

  4. Pattern recognition cannot confirm the most probable diagnosis. With history of change, dermoscopic clues of ulceration and polarising white lines, excisional biopsy is mandatory and hopefully this does not come up with melanoma.