1300 856 695
+44 203 514 0688
1800 867 1390Case discussion: How would you treat this patient? [27 June]
This week we revisit an engaging case from Dr Tim Aung. A 55-year-old female presented with 1-2 years’ history of slow growth of an asymptomatic, non-tender lesion on the upper chest. Please review the images.
What is your impression, what is the differential diagnosis, and (if you would biopsy) what technique would you use?
Update:
These are the results from the pathology report. What do you think now? How would you treat further?
– Prof David Wilkinson
We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.
1300 856 695
+44 203 514 0688
1800 867 1390
Growing lesion on an adult, and nodular appearance – need excision biopsy.
Dermoscopoically – not much chaotic appearance. maybe polarised white lines.
features are suggestive of Dermatofibroma. However, Df’s are mostly seen in extremities.
Age 55, growing, nodular appearance – suspected for melanoma, need excision.
Dermatofibroma.
I will leave it alone.
Loss of pigmentation centrally and irreg outline. Increase size. Theregore exsicion biopsy with adequate margin and sent for histopathology.
This looks like a classical dermatofibroma image to me both microscopically and dermoscopically. I will reassure and advice for whole body skin check
DF leave alone and reassure
dermatofibroma
Dermatofibroma
need to consider nodule SCC
Central white structureless Peipheral regular brown reticular pigment. Macroscipically and Dermatoscopically suggests a Dermatofibroma
Keloid
None pigmented melanoma
Dermatofibtoma
2 mm excision
My clinical and dermoscopic impression is dermatofibroma.
DD
XANTHOGRANULOMA
DERMATOFIBROSARCOMA
However non of dermoscopic ccc are displayed
My approach If it is cosmetically bothering this lady I would remove it, others than this I will reassure her.
Dermatofibroma,
Slow growing. Reassure
It looks like a dermatofibroma
But it is raised which is unusual
For this reason I would punch biopsy it
Older person, slowly growing, striated colouration on dermosocpy.
Dermatofibroma is possible.
It would be helpful to know the result of the ‘pinch test.
Punch biopsy would be an easy and quick way of settling the matter.
Even if it is benign, she may appreciate its removal given the position and the fact that it is growing.
looks like dermatofibroma, if on palpation it feels like dermatofibroma I would assure and leave along but if not could consider punch biopsy
Rounded smooth raised/ nodular skin lesion.
Dermatoscope: clear Centre with faint radial white lines.
Impression DF
Do dimple test. Ask about any history of local trauma or insect bite.
DD; DF, Keloid, burn, as she is old just to consider nodular melanoma which is not the case at all.
Excise and send for HP if it’s bothering the lady. Otherwise leave it.
Dermatofibroma
dermatofibroma for exisiln or cryo
It looks like a dermtofibroma to me. DD could be amelanotic melanoma but seems unlikely given the slow growth and lack of symptoms.
But if it keeps growing, or patient is concerned, or patient high risk for melanoma, I would suggest to excise it. Probably just with a 2 mm margin.
dermatofibroma, keloid scar, amelanotic melanoma. Biospy with 4-6mm punch.
Probably a benign lesion like a DF and history probably not quick enough for a NM but this lesion needs further evaluation apart from clinical examination.So,cosmetically sensitive excision biopsy with 2-4 mm margin.?NM
Looks like detmatofibroma, but as EFG, would do excision biopsy with 2 mm margin
KELOID in keloid area
Hands off
Kenacort injection if patient requests
Appearance clinically & dermoscopically of dermatofibroma. However concerned by history of ongoing growth which wouldn’t expect with dermatofibroma. Pink growing nodule. Hence would excise with 2mm margin
DFSP
BIOPSY THEN EXCISION WITH WIDE SAFETY MARGIN
LN BIOPSY MAY BE NEEDED
Dermatofibroma
Shave biopsy
Dermatofibroma?
Biopsy is excision
looks and sounds like a dermatofibroma
If the patient was concerned or unhappy with appearance or catching /bleeding etc then consider elliptical excision
Looks like Dematofibroma rule out Scar on clinical and dermoscopic image. However the history of lesion growth, location of the lesion, patient’s older age and that patient is concerned , it’s worth checking to rule out Nodular/Amelanotic MM. Hence, I would probably excise it with 2mm margin for safe practice and peace of mind for both patient and doctor.
The differential diagnosis are Leiomyoma and Neurofibroma. Needs excision biopsy.
it is a benign lesion, a fibroma. We can remove it
dermatofibroma or keloid, if there is a history of trauma
I would not biopsy it
Dermoscopoically – Dermatofibroma
Klinicaly – slow growth nodular lesions. A 55-year-old female.
Dif.Dg. Melanoma?
Suspected for melanoma, need excision.
It looks like dermatofibroma on both macro- and micro- scopic images. If it feels like the one too on physical exam, I will reassure patients and discuss management if she would like to get read of it for cosmetic reason
Looks very much like a dermatofibroma but elevated firm and growing could consider ex bx
Depends on history – any previous trauma or biopsies
Dx. Dermatofibroma keloid neurofibroma
If concern or no previous trauma history punch biopsy 3mm punch and review warning pt that if keloid may get worse
Would appear to be benign and is completely excised with 3 mm margins so reassure patient.
I suggest that the key issue in a case like this is: it looks very much like it is a DF or a keloid scar clinically, BUT what am I missing? Is there anything it could be that is more serious, and that I must not miss? What about rare but horrible things like desmoplastic melanoma? This is how I try to think. If it is a DF or a keloid, I risk making it worse if I excise it! So, what to do? Discuss openly with patient, explore history carefully and then make a shared decision about whether to leave alone or excise, noting pros and cons