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Case discussion: How would you treat this patient? [3 August]
In this week’s new case discussion from Dr Cheh Goh, we present the following:
- 78 year-old female patient
- Indistinct lesion above right eyebrow
Please review images (accept our apologies for the out of focus clinical image). What would you do next?
Once you have made your assessment, scroll further for the pathology report!
Here is the pathology report. A surprise? What now?
We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.
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1300 856 695
+44 203 514 0688
1800 867 1390
is there any lymph node enlarge or palpable
I am not sure but from picture,it look like cystic nodule
is it dark in color as it appear infected,pustular
Sorry cannot make much of photos. Clinical appear to show erythema and scale. The dermatoscopic picture also difficult to visualise as the autofocus has been attracted to the eyebrow and bubble in the gel, soiam unable to see if there is a pigmented lesion there. But clearly an important diagnosis. Assuming that her general health is favourable at 78 this will require wide excision which is going to include the eyelid so I would be thinking oculo-plastic surgeon. If is truely 0.4mm thick this is optimistic for prognosis but scalp sites do worse and I would think this site is also unfavourable.
The magnified photo reveals capilaries and redness which is irregular. There is clearly sun damage to the area. I would recommend a 4 mm biopsy above eyebrow area and then appropriate management .
looked like grade 2 Actinic keratosis to me lol. wish the macroscopy was clear though
A compelling case that shows the value of dermopscopy. Clinical image is not very impressive (sorry that it is not focussed), and could be “just about anything”. However, it must be something! The dermosocpy shows pigment! That is a worry. Biopsy essential – because of the site I would do 1-2 large punches, and WOW it is a melanoma. Off to the ocular surgeon!!! The lesson for us? Everything has to be something – our job is to get a diagnosis, not “leave it and hope:”
Well said David W
Sorry the clinical picture was out of focus
The main focus is on the dermoscopic photo which was taken with an IPhone through the lens of a 20+year Heine
One can see “Tiny clusters of baby spiders ie abnormal pigmented patterns “in a field of severe sun damaged skin
The purpose is to avoid treating this sort of lesion with topical modalities
Hence as skin cancer clinicians, we should try to reduce the presentations of CUP ie Cancer of Unknown Primary
PS the case was referred to a panel of plastic surgeons for further management
Good pick! – could very easily have been missed. Thanks for sharing