Case discussion: How would you treat this patient? [18 October]

In this week’s case discussion, submitted by Dr Terry Harvey, we look at the case of a 72-year-old male patient who presented for a routine full-body skin cancer check.

A subtle thickened area measuring 24 x 18mm was present on his left anterior shoulder (lesion circled in wide image).

  • 72-year-old male patient
  • Thickened area 24 x 18mm

What is your evaluation of the images, and what would you do next?

case discussion


Here is the pathology report. What is the best treatment here, and why?

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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20 comments on “Case discussion: How would you treat this patient? [18 October]

  1. Arborizing vessels and fine telangiectatic vessels
    Whitish background

    DX Morpheaform basal cell carcinoma

  2. Taking the age and the dermatoscopic view of multiple branching blood vessels in keeping with BCC. Excise it.

  3. BCC, trial with cryotherapy 2 weekly cycles to good effect. Can do punch to confirm if you’re not confident on the diagnosis

  4. Possibly BCC or poorly differentiated SCC or amelanotic melanoms. Serpentine vessels surround a pinkish white area which appears out of focus

  5. Dermatoscopic image suggests BCC,possibly mixed micro nodular and infiltrating(morphoeic).Margins unclear.
    I would punch biopsy to get a tissue diagnosis—-if infiltrating BCC then at least 5mm margins . If anxious re closure,refer to a plastic surgeon(not a Mohs micro graphic surgeon) as even in a 72 yo male, this is a cosmetically sensitive area.

  6. Another really nice case from Terry – these lesions are only identified when you look very carefully, and “actively”. That is, not just scanning the skin, but “really looking”. A punch or a shave is the right move nest, and then, a wider excision once diagnosis is confirmed. It is not correct to do an excision without a biopsy: why? Because you need to know the specific sub-type, you need to know whether there is perineural invasion or not, before you can select the correct margin, and plan any other treatment.