Case discussion: How would you treat this patient? [29 March]

This week’s case discussion from Dr Dave Stewart features a 56-year-old male patient with a lesion found on his nose at his routine skin check. The patient felt it was just from his glasses rubbing on his nose.

  • 56-year-old male
  • Lesion on nose
  • Patient felt it was from glasses rubbing

How do you evaluate the clinical and dermoscopic images? What would you do next?

case discussion

Update

Here is the pathology result. What are your treatment options and pros and cons?

pathology

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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15 comments on “Case discussion: How would you treat this patient? [29 March]

  1. A fair skinned patient with actinic elastosis and telangiectasia. It looks like a Non melanocytes lesion with irregular borders. A few white thick parakeratotic rings at 9 o’clock and fading the normal skin structure at 12 o’clock position with sclerosing pattern with some fine arborising vascular pattern. I am thinking of superficial multifocal BCC or an early IEC/ SCC. I’ll do a 2 mm punch bx at the 9 o’clock position of this lesion.

  2. I think the collection of fine arborising blood bessels give at max magnification give the game away – likely BCC – punch biopsy and manage from their

    1. If punch is a challenge may consider deep shave biopsy or excision or a field treatment after confirmation of non melanocytic lesion.

  3. asymmetry, neo vascularisation – arborising vessels, white lines, abscence of pigment network
    ? BCC
    punch biopsy

  4. Macro and dermoscopically looks like fibrosing BCC. Confirm with biopsy of choice. As edges are ill defined and fibrosing BCC is high risk of recurrence, consider Mohs surgery referral once confirmed

  5. Definitely not due to glasses
    The lesion has arbourizing vessels. There is a central white scar like area and chronically sun damaged skin.
    Differential would be BCC,SCC,AK,Amelanotic Melanoma
    2 mm punch biopsy would be the way to go.

  6. The amount of ‘whiteness’ in this area makes me consider these differentials – sclerosing BCC, basosquamous lesion, or even SCC (with telangiectasia from solar damage). I would do a shave biopsy to obtain histo confirmation.

  7. This is a great case. Clinically, looks like a scar, and (as skin cancer doctors we know this means morphoeic bcc is likely). And, important not to be distracted by the patient’s history / explanation. Then, yes a punch biopsy (at least 3mm, if not more). With the diagnosis confirmed, the only treatment is surgery, with wide margins (5-6mm).

  8. A lesion on the patient nose with abnormal vessels and some scar tissue specially in the upper part. There is a grey ovoid nest in 5’ in dermoscopy.
    Bcc is working diagnosis. The patient need a referral to skin surgeon for a flap surgery due to the site and size of the lesion.