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?
Here is the pathology report. What now?
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22 comments on “Case discussion: How would you treat this patient? [31 October]”
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.
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 .
White lines, ulceration and blue clods. All in keeping with PBCC. Since it’s raised then nodular type perhaps.
Excise and send for HP.
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.
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