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!

Case discussion      Case discussion

Here is the pathology report. A surprise? What now?

Case discussion

We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.

MORE CASE DISCUSSIONS


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7 comments on “Case discussion: How would you treat this patient? [3 August]

  1. 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

  2. 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.

  3. 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 .

  4. 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:”

    1. 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