Case discussion: How would you treat this patient? [30 January]
In this week’s case discussion, we revisit an interesting case from Dr Slavko Doslo. An 80-year-old male patient reports an ulcer on his finger that is slow to heal over the past several weeks.
What do you see, and what is your differential diagnosis? What would you do next?
Here is the pathology report. Is this finding surprising?
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19 comments on “Case discussion: How would you treat this patient? [30 January]”
Circular raised pink-white lesion with ‘lustrous’ rim and central ulceration with scale; a few arborising vessels are present.
Likely BCC, DDx Scc.
For biopsy and excision
White structure + ulcer
SCC or Pyogenic granuloma. Requires excisional biopsy
melanocytic pigmentation about the edge of the ulcer – assume melanoma.
Likely Clinical SCC – needs a wide excision however might be best tackled in 2 stages due to location and inflexibility of the skin here. Incisional biopsy initially then 6 weeks later wide excision.
Small wedge excision for diagnosis
SCC? Excition biopsy.
likely a moderately differentiated SCC with ulceration
This appears to be an SCC. The edges are raised & keratotic with no pearly edges or telangiectasia. The keratotic roof has been scratched pff or knocked off/ Excsional biopsy with a generous margin is called for & is likely to necessitate at least a V-Y island flap.
Suspicious for amelanotic melanoma; excise with 2mm margin initially
It looks like an SCC but there is some pigmentation at the periphery of lesion. Differentials are solar keratosis, BCC and melanoma in solar keratosis. It should be confirmed with a punch biopsy.
White circles, scaring keratinised area, ulcer with dot and glomerular vessels.
? SCC? BCC
REFER TO PLASTICS FOR BIOPSY
Appearance suggestive of KA or nodular BCC; punch biopsy for assessment
central Ulcer with Rolled Elevated Margins , has keratin – SCC
Need Excision of lesion
Likely ulcerated SCC.
Needs excision with flap.