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1800 867 1390Case discussion: How would you treat this patient? [27 February]
This week’s case discussion, submitted by Dr Renuka Ranasinghe, features a 79-year-old female patient with Type I skin and a history of multiple non-melanoma skin cancers as well as a melanoma on her left eye.
This pink scaly lesion was found on her left upper arm during her skin check. The patient reports that the lesion came up suddenly.
What are your thoughts here? What would you do next?
Update
Here is the pathology result.
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1300 856 695
+44 203 514 0688
1800 867 1390
Looks like superficial BCC. I’d treat with curette and cautery and see what pathology shows.
I would do excisional biopsy with 2 mm or 3 mm margin. Needs pathology
Superficial BCC,Shave biopsy and wait for histology .
Excision biopsy with 2mm margin
? BCC
Bcc excision biopsy
An adequate excision biopsy of lesion and histopathology. ? A melanocytic melanoma.
Suprficial/ nodular BCC
Punch biopsy to confirm
3 mm punch biopsy
Possible SCC
Probably bcc
Possible amelanotic mm
Looks like a BCC
Shave Bx for histo
BCC. Punch or excisional biopsy.
Approximately 8-9mm roughly circular lesion. Irregular pink/white with some white structureless features throughout. No arborising vessels or other obvious blood vessel features.
Likely superficial BCC but amelanotic MM not ruled out given history.
Deep shave or curette would be a quick option. Straight forward position for excision, so consider excision with 3 – 4 mm margins for more definitive approach.
SCC
A quick growing slightly raised red plaque + her strong PHx of Melanoma and NMSC’s, is a red flag clinically. Dermatoscope image = no clear features, an erythematous plaque with mainly linear irregular out of focused BVs, may be a small erosion/ulcer at 11 O’clock. Some central keratin white structures.
IMPRESSION = a more aggressive SCC, vs a BCC v s an amelanotic melanoma. All 3 are a possibility.
PLAN= excision biopsy with 3 mm margins, if possible, otherwise a biopsy then management based on histology.
BCC – excision
Asymmetric pink white lesion
Amelanotic melanoma possible; DDx include SCC
Excision biopsy 2mm margins
This is a rapidly growing I’ll-defined lesion which is asymmetrical and with some amorphous areas.
Differential included SCC, BCC or (with her previous history) amelanotic melanoma and therefore I would excise completely.
Need to r/o Bowen’s disease or SCC
1-?Nodular BCC 2-for biopsy
It is pink with white lesion suspicious for BCC . I would do a punch biopsy to confirm diagnosis and then discuss treatment.
This is a BRILLIANT case!
Well done to Dr Renuka Ranasinghe, hat off to you mate! Your DDx was spot on!
Honestly, on first glance, it is so easy to brush this off as a keratinocyte carcinoma: the scales and white fluffy clods on a pink background, likely just AK, or sBCC.
But the fact that it came up suddenly is a big clue: BCCs dont grow suddenly; SCCs can grow suddenly, but mostly in the KA form, and those have quite distinct looks.
Thanks for sharing this case.
Thank you Shawn H ..it was the polymorphic vessels and history that alerted me