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


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. Looks like pigmented BCC to me. I’d probably remove the whole thing with a 4mm punch biopsy and go from there

  3. 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.

  4. 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.

  5. 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.

  6. 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 .

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

  8. It looks like a nodular BCC or a nodular melanoma.
    This is a cancer:
    + blue/white structure

    I would get rid of it with 3mm margin and see what the pathologist thinks.

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