Case discussion: How would you treat this patient? [14 February]

In this week’s case discussion, submitted by Dr Mohammed Hussain, we look at the case of 72-year-old male patient with a lesion on his forehead. Please review the clinical and dermoscopic images – what do you think and what would do you do (if anything)?

case discussion

Update

Here is the pathology. Any reactions?

case discussion

 

 

 

 

 

 

– Prof David Wilkinson

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18 comments on “Case discussion: How would you treat this patient? [14 February]

  1. Most likely pigmented BCC – no harm in biopsying a pigmented area, and if confirmed, full excision. If biopsy not definitive though, an excision with 2mm margins ….

  2. background of Chronically sun-damaged skin with a pink macule/Papule.Dermoscopy image is not clear.Could be globules or ovoid nests. I would do a punch and wait for a confirmed disgnosis.

  3. i think is BCC
    need excision biopsy
    according to risk low,high risk area we need to do excision
    i think if low risk need 4mm margins and clear deep plane
    if high risk need > 5mm margins and clear deep plane

  4. it is a pigmented lesion but the dermoscopic image is not clear. the three-point checklist is zero. I consider it as a benign lesion, a lentigo. For treatment, I propose to leave it according to the age and claim of the patient. I suppose that it does not annoy him.

  5. I think this is a great teaching case, and a very common real life case. The lesion has both plausible benign and malignant diagnoses. The dermoscopy is not definitive, at all. So, it needs a biopsy. As it is small I would do a “punch excision biopsy”. That is I would use a punch biopsy tool that is big enough to remove the whole lesion (just in case it is a melanoma). Then, when a benign diagnosis come back – like in this case – no harm is done, and no further treatment is needed.