Case discussion: How would you treat this patient? [7 November]

This week’s case discussion, submitted by Dr Randa Al-Hajali, features a 75-year-old male patient with a growing lesion on the concha of his ear. The lesion has been painful and frequently bleeds.

What do you think, and what would you do?

case discussion

Update:

Here is the pathology report. How would you treat this lesion?

case discussion

case discussion

 

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22 comments on “Case discussion: How would you treat this patient? [7 November]

  1. Pink-white lesion, ulceration, some scale, perhaps a few abnormal vessels. Likely malignant
    Punch biopsy and then excise accordingly.

  2. Lots of keratin. May be a SCC. Will take a biopsy to know margins for excision. Flap or full thickness graft may be options

  3. Suspicious lesion . Most likely SCC or less likely chondrodermatitis nodularis.
    Punch biopsy is a must and treat accordingly . Full thickness graft if malignant .

  4. BCC – Basal Cell Cancer – Nodular Type
    will excise this atleast 2 -3 mm margin and Graft from Preauricular Site vs a Pull through Flap

  5. Ulcerative area, tortuous vessels points to BCC nodular type. Excise to rule out. Not sure how to be removed from that tricky area.

  6. The tenderness suggests SCC/Merkel/AFX
    Surgically Remove under LA with 2-3 mm margin down to the cartlege with a 15 blade then with blunt dissection underneath the lesion . Place an indicator at 12(eg small ink dot) and let heal by secondary intention while awaiting the histo
    Manage accordingly
    No point doing a partial biopsy of such a small lesion
    Secondary intention healing of the ear generally works extremely well.
    I think anything else is excess to needs and often doesn’t have any better result, And cost the community a lot more money. I don’t think there’s any indication for graphs or flaps or partial biopsies

  7. Growing lesion on ear. Painful and bleeding.
    Dermoscopy shows ulcerative lesion with white structure.
    I’m thinking this may be an SCC.
    I will do punch biopsy to confirm before doing procedure on ear concha.

  8. Clinically a tender growing bleeding nodule is suspicious.
    Dermatoscopically= vascular nodule, some radial linear irregular BVs, with some white keratin structures
    IMPRESSION = most likely a SCC, but a BCC or an amelanotic melanoma needs to be excluded.
    PLAN = initial biopsy, then management based on histology.

  9. The lesion is painful, symmetrical, raised, with arborizing blood vessels , bleeding. High likely nodular BCC but Merkel’s cell carcinoma is differential diagnosis . Needs to be excised.

  10. According to the histopathology report , wide excision should be done for definitive diagnosis followed by either a Graft or pull through flap .

  11. This is a case of skin cancer that I believe should be managed by a team including a plastic surgeon/ENT and/or oncologist.
    This tumor is negative for keratin markers. Pathologist can’t make a diagnosis in this report/ doesn’t know what this tumor is. I would ask if there is a history of any other cancers with the chance of skin metastasis. pathologist needs the whole tumor to make a diagnosis and this tumor is next to auditory canal with possible extensions inside the ear. may need whole body CT for staging + wide excision.
    I think Primary Care limitations can’t allow for further excision in this Scenario. I would refer this patient.