Case 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?

case discussion


Here is the pathology result.

case discussion

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22 comments on “Case discussion: How would you treat this patient? [27 February]

  1. 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.

  2. 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.

  3. 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.

  4. It is pink with white lesion suspicious for BCC . I would do a punch biopsy to confirm diagnosis and then discuss treatment.

  5. 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.