Case 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?

case discussion

– Prof David Wilkinson

Update

Punch excision biopsy showed nodular BCC with margins clear. What would you do next?

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26 comments on “Case discussion: How would you treat this patient? [6 December]

    1. Sorry Dr Koshy – technical glitch on our side! You should be able to zoom now.
      Thank you 🙂
      Abbie – HealthCert Education

    1. Sorry – technical glitch on our side! You should be able to zoom now.
      Thank you 🙂
      Abbie – HealthCert Education

  1. This could be Nodular BCC
    SHOULD get a partial biopsy , With preference 4 mm punch biopsy .
    For4 diagnosis purpose.

  2. Has the appearance of nodular BCC, although unable to Zoom. Cryotherapy may not penetrate deep enough to clear so excision biopsy 4mm margin

  3. 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.

  4. 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)

  5. 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.

  6. Macro has rolled pearly edge and central debris BCC, or possibly SCC.
    Would definitely excise, consider punch biopsy first.

  7. 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.

  8. 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.

  9. 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.