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1800 867 1390Case discussion: How would you treat this patient? [6 December]
This week’s case discussion from my own practice features a middle-aged woman who presented for a skin check with little medical history of note. On examination this small, pink lesion was noted.
- Middle-aged female
- Small, pink lesion noted
What is your differential diagnosis and what would you do next?
– Prof David Wilkinson
Update
Punch excision biopsy showed nodular BCC with margins clear. What would you do next?
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1300 856 695
+44 203 514 0688
1800 867 1390
SCC – excisional biopsy
superficial BCC
BCC with typical of white clues
cannot zoom in, looks like pigmented AK- treat with Cryotherapy 2 weekly basis
Sorry Dr Koshy – technical glitch on our side! You should be able to zoom now.
Thank you 🙂
Abbie – HealthCert Education
can’t zoom
Sorry – technical glitch on our side! You should be able to zoom now.
Thank you 🙂
Abbie – HealthCert Education
This could be Nodular BCC
SHOULD get a partial biopsy , With preference 4 mm punch biopsy .
For4 diagnosis purpose.
Has the appearance of nodular BCC, although unable to Zoom. Cryotherapy may not penetrate deep enough to clear so excision biopsy 4mm margin
Physically raised skin colored lesion with pearly edge. Dermatoscope shows pink area with subtle hemorrhage and some white lines. I am inclined to bcc. Excise it.
I forget the surface scales. So another DD can be BSC.
Keratinocytic lesion. half of the lesion appears to have been cryo cauterised ( presence of the tell tale white – pale area ) Structureless pink Base. Single large blue – grey clod present and a a tiny are of erosion present. No vessels seen. Lesion appears to be a partially traumatised Basal Cell Carcinoma. ( or can I say, partially cryo cauterised BCC)
Partially traumatised/Cryo cauterised lesion
I would Excise the lesion.
On Zooming the lesion, there is a blue sticky fibre present.
In view of the blue-grey clod, the structureless pink base, the Clinical Impression is a Basal Cell Carcinoma.
BCC Needs to be excised.
DD: BCC/amelanotic melanoma
Excisional biopsy with 2mm margin
linear and haorpin blood vessles .dilated hair follicles
kerato acanthoma for cryocautry
Macro has rolled pearly edge and central debris BCC, or possibly SCC.
Would definitely excise, consider punch biopsy first.
Ulcerated Nodular BCC keeping in mind can be KA
I would do a curative excision down to Frontalis
Looks squamous lesion P.D. KA/SCC. D.D. Verruca
atypical blood vessels, keratosis, pink and structureless white
?possible white lines
verrucous SCC
excision
excision biopsy ? BCC
Difficult one. Could be BCC, SCC or Amelanotic Melanoma. I would excise with 4mm margin which would be sufficient for the first two possibilities and diagnostic for the thrid.
BCC
Classic Rolled edge
Pearly white
3 mm Punch or shave Bx
The differential diagnosis of this lesson is Angiofibroma, Amelanotic melanoma.
Dermoscopy shows us a lesion without a network or blue-white structure. We have only irregularity of structure. We are waiting for the anatomy pathology result. we hope that we will have from them the Clark and Breslow stage or an ‘onion skin’ pattern around vessels and follicles and vascular proliferation.
the patient seems to have a scar of a similar lesion near the current lesion.
When i saw this patient, the clinical / dermoscopy diagnosis was far from clear. It did not look like an obvious nBCC to me, so I did a punch biopsy, as I always do for pink lesions like this. nBCC was confirmed and although margins were reported as clear, as my punch biopsy was NOT done with a curative intent (it was a diagnostic intent) I re-excised with 2-3mm margins to ensure cure.