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1800 867 1390Case 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?
Update
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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1300 856 695
+44 203 514 0688
1800 867 1390
Arborizing vessels and fine telangiectatic vessels
Pigmented
Whitish background
DX Morpheaform basal cell carcinoma
arborising vessels and sum white structureless areas
Advise Bx
Looks like a BCC with arborising blood vessels . need biopsy
Looks like a classic infiltrating BCC to me with arborizing vessels and erythematous background.
I personally wouldn’t bother with a biopsy. I would just excise.
Superficial BCC; great arborising blood vessels
Punch biopsy then excision
Taking the age and the dermatoscopic view of multiple branching blood vessels in keeping with BCC. Excise it.
BCC. For excision
amelanotic melanoma versus BCC
EXISION BIOPSY
BCC, trial with cryotherapy 2 weekly cycles to good effect. Can do punch to confirm if you’re not confident on the diagnosis
Polymorphous vessels, white structureless area
for biopsy ? BCC
Excision biopsy with 2mm margin – ? BCC
Possibly BCC or poorly differentiated SCC or amelanotic melanoms. Serpentine vessels surround a pinkish white area which appears out of focus
Infiltrering BCC. Excision with good marginal
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.
Most likely bcc due to arborisation bu need to biopsy 3mm to decide best management option
I will refer him after deep excision of the lesion.
Wider excision with 5mm margin indicated
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.
Excision with 5mm margins