Case 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?

case discussion

Update:

Here is the pathology report. What now?

case discussion

case discussion

 

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22 comments on “Case discussion: How would you treat this patient? [31 October]

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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 .

  6. White lines, ulceration and blue clods. All in keeping with PBCC. Since it’s raised then nodular type perhaps.
    Excise and send for HP.

  7. 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.

  8. The lesion is most likely a pigmented nodular BCC with a distant possibility of atypical nodular MM.
    Management- Excision with adequate margins.