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1800 867 1390Case discussion: How would you treat this patient? [13 February]
This week’s case discussion, submitted by Dr David Stewart, features a 73-year-old male patient with a lesion on his right ear detected during his routine skin cancer check.
The patient reports that the lesion has been present for many months and doesn’t bother him.
What are your thoughts on the clinical and dermoscopy photos? What would you do next?
Update
Here is the pathology result:
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1300 856 695
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1800 867 1390
suspicious because have change the colour to be pale and red
Clinically a NMSC until proved otherwise. A non-pigmented lesion with a rolled edge and a vascular center.
Dermatoscopically = in focused arborizing BVs = likely a Basal Cell Carcinoma: differential diagnosis a SCC, adnexal tu. or amelanotic melanoma less likely.
PLAN = because the size and a higher risk site (R ear helical rim), a punch biopsy first, then management based on histology. Especially if it is one of the more aggressive BCC sub types, like morpheic, sclerosing or infiltrative = a bigger margin would then be needed.
? BCC
Wedge excision biopsy
It’s a BCc
That single big arborising blood vessel bottom right may be giving it away.
BCC likely, white-pink in colouration.
Punch biopsy and then excise with wedge excision.
Dermatophytes/ Fungal infection or Contact dermatitis.
?BCC
Shave biopsy. Single advancement helical flap if confirmed
I’d probably call a BCC
Punch bx to confirm. Any component of Infiltrative BCC is concern for margins; thinking single flap vs H plasty
Punch biopsy to exclude BCC
Nodular BCC
3 mm punch Bx
looks like a small BCC arborised
likely morpheic type bcc; shave Bx to confirm, then plan complete excision.
BCC. Punch biopsy and refer
BCC until proven otherwise
proceed to punch biopsy
? BCC. Shave biopsy to confirmed
Depressed non pigmented lesion with arborising vessels. No other distinctive features. Morphoeic BCC. Biopsy then Slow MOHS and ? FTSG vs Wedge resection. Not sure if H-Plasty will be possible. Diff Dx :Amelanotic melanoma
BCC
Biopsy for diagnosis
Bcc excision