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1800 867 1390Case discussion: How would you treat this patient? [20 September]
This week’s case discussion, submitted by Dr Mazharul Islam, features a 65-year-old female patient with no significant history. This pink lesion is noted and photographed at a 3-month interval.
- 65-year-old female patient
- Pink lesion noted
- 3-month interval
What is your evaluation? What next?
Update
Here is the pathology report.
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1300 856 695
+44 203 514 0688
1800 867 1390
i am not sure how long has had this lesion ,if new spot maybe do biopsy ,otherwise i will take picture and review in 2 months
the lesion looks atypical with tan like structureless areas,non melanocytic with vessels that also look atypical.
needs a biopsy.Punch vs excision?
differential should include an amelanotic melanoma
Looks like a BCC
I would do a re excision with a 2mm margin
I can only see multiple clods/ dots. But taking into consideration the age and as a physical red spot. Perhaps to biopsy it just in case to rule out any nasty growth.
Depending on time insitu, monitor or biopsy. Clinical image looks Seb K-ish, however microscopic images show structureless lesion with scattered red dots.
structureless background with dot like vasculature scattered regularly and no pigment whatsoever. i think we should go ahead with follow up dermoscopic pictures
Will proceed with punch bx specially if patient had previous skin malignancies.
faint pink background
poly morphus blood vessels
blur gray globules
?? bcc or hypomelanotic melanoma
phenotypically looks like seb k, dermoscopically chaotic. benefits from excision to exclude amelanotic melanoma
White structureless ares and glomerular type dotted blood vessels suggestive of Bowens disease. I would punch biopsy.
Looks like a BCC – there is evidence of interval change in the dermoscopic images – recc biopsy with 4mm margins .
Biopsy
The lesion is a recent nevi ( + 3 months ) on a the 65 year old . it is new because it does not exist in her history . Dermoscopy show us lesion that grow . 1-2 cm increased in 3 months The structure of the lesion present globular structures , small vessels and other structures . The Age of the lady , structures of the image and the rapid grow lead me to say that it is a malignant nevi . We have to do a Excisional biopsy for diagnostic and excisional biopsy for treatment
I think this lesion is a perfect candidate for a quick punch or shave – that is the guidance for pink lesions. It certainly needs a biopsy if it is solitary
This one is obviously , unequivocal seb keratosis , unless pain to touch . If not -tender for that lesion , that is unequivocal seb K with well dermercated Border and yellow clod on Non polarised, no white line on polarised