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1800 867 1390Case discussion: How would you treat this patient? [31 October]
In this week’s case discussion, submitted by Dr Robert Teunisse, we look at an 80-year-old male patient with an unusual nodular lesion on his right shoulder.
What do you think, and what would you do?
Update:
Here is the pathology report. What now?
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1300 856 695
+44 203 514 0688
1800 867 1390
Bcc. Do a deep shave bx now and await histology to plan further treatment.
BCC Probable nodular with blue clod indicating deep ? Invasion plus more centrally placed spokewheel features of bcc and central white polarized lines on a pinkish homogenous background
Excise with 5mm margins.
Bcc needs excision.
Looks like pigmented BCC to me. I’d probably remove the whole thing with a 4mm punch biopsy and go from there
Features consistent with pigmented BCC –clods and spokewheel features.Excise with 5mm margin.
Clinically a suspicious shoulder nodular lesion
Dermatoscopically= crystalline white lines on polaroid light. Oval blue structures, with a few small black- blue globules. Some small pigmented concentric structures. A clear margin with a dirty grey clear stroma with an erythematous area.
IMPRESSION= My pick would be a Nodular Basal Cell Carcinoma. A nodular Melanoma needs to be excluded.
PLAN= Full excision with at least a 3mm margin. Further management is based on histology.
Ugly duckling
Features consistent with BCC – bluish pink colour; no arborising vessels visible however, some white / crystalline structures, specks of brown pigment.
Alternative is amelanotic melanoma
Excise simple ellipse 2-3mm margins.
Nodular tumour with nil history of growth provided.
Dermoscopy indicates blue grey pigment, polarised white clues, indiscriminate blood vessels
Impression: Nodular BCC or melanoma
Potential management: excision with 5mm margin if considered aggressive, 3mm margins if considered non-agressive.
Need to exclude nodular melanoma from differentials, hence excision decision.
The history is important but not included .
It could be nodular Bcc or nodular amelanotic melanoma .
5 mm excision is appropriate.
If it is a nodular bcc ,so the excion could be complete . However if it is melanoma ,it may need further wide excision depending on the histopathology .
Pigmented BCC
Excision
White lines, ulceration and blue clods. All in keeping with PBCC. Since it’s raised then nodular type perhaps.
Excise and send for HP.
Pigmentet BCC
It looks like a nodular BCC or a nodular melanoma.
This is a cancer:
Chaos
+ blue/white structure
I would get rid of it with 3mm margin and see what the pathologist thinks.
Pigmented BCC
Has all criteria for BCC. A punch biopsy would be advised before excision to exclude melanoma
exclude melanoma. excise
LEAF LIKE STRUCTURE, BLUE GRY OVOID NEST I THINK BASAL CELL
The lesion is most likely a pigmented nodular BCC with a distant possibility of atypical nodular MM.
Management- Excision with adequate margins.
pigmented BCC – can treat with cryotherapy in monthly cycles , ive had excellent results
Pigmented BCC, would do punch excision .. may need further margins depending on pathology.
elliptical excision with 3mm margin
looks like BCC could be melanoma
BCC