|Skin Cancer Doctors Ltd - Whangarei||
The pattern is that of blue/grey clods with the clods arranged in a pattern of their own ( used to be called the maple leaf effect) The surrounding skin coloured area looks raised and the central vessels are called are polymorphous with curved, branching and serpentiine vessels that suggest that it is in deed a raised lesion. The most likely Dx here is a pigmented nodular BCC and the differential includes Melanoma and Seborrheic Keratosis.
I have uploaded this image from a patient I saw a few days ago that has similar features to the case above but not quite so obvious. Once again the pattern is that of brown/grey clods and there is chaos. The clinical appearance is often very important in these cases as they feel raised and the surface glistens as though the skin is being stretched and you would imagine that there was fluid underneath. Once again this is likely to be a pigmented BCC. It is difficult to see the blood vessels in this case as it is an earlier lesion so is unlikely to be nodular - more likely to be a superficial BCC. BCC's are an excellent example of why taking pictures of skin is not sufficient. Feeling the lesions is part of the assessment.
This lesion is on the leg of an older lady and has been present for a couple of years. Recent changes.
This is a thickened hard lesion with coiled blood vessels at 12 o'clock. Likely to be an SCC. This lesion needs to be excised.
This lesion is on the leg of the lady above. There is very little thickness to this lesion and there are some dot vessels seen at 3 o'clock. This is likely to be Bowens' (SCC in situ) Options for treatment is to remove or freeze/thaw/freeze and review in three months. Some people use Efudix to treat these
81 yr old man who has had several BCC's removed in the past has this pigmented lesion on his shoulder
Same man with the lesion shown on Dermatoscopy.
There is ulceration with chaotic pigmentation. A clue is that there are blue clods present and with his Hx of BCC's this is likely to be a BCC.
This spot was found in the middle of a 60 yr olds back
It looks like there is a central scar which is probably from someone doing a biopsy from this lesion in the past. Has it changed - who knows. There is a reticular pattern with thickened lines and in some places the lines are thicker than the width of the space between ( a clue to melanoma) The lesion is asymmetric with irregular pigmentation. It is likely that this is a Clarks nevus however it is a lonely lesion and a biopsy or close dermatoscopic followup would be reasonable.
Another shoulder lesion that has a waxy appearance. The clue here is the multiple different coloured clods This is a Seborrheic Keratosis
This lady has a new lesion on her ear that is not healing.
We are presented with an ulcer that is new and the surrounding skin that appears to be normal.
The way I would manage this is to assume that this is Actinic Keratosis and cryotherapy with 3/12 review is appropriate
This lady has had a lump in this area for over two years and in the last few weeks it has looked like this.
The orange jelly like fluid centrally with normal surrounding skin suggests that there has been a cyst on this ear and that it has been damaged. The way I would manage this is to wait and see if it heals over a month.
This man has a history of BCC's and this spot was found on a general examination.
In the centre of the picture is a light brown / orange cystic lesion with blood vessels arching over the lesion. This is likely to be a small BCC. Histology - Nodular Basal Cell Carcinoma (BCC)
This was found on a routine check The pattern is brown coloured clods with looped blood vessels. The finger like projections are clearly seen and are characteristic of a Seborrheic Keratosis.
This is a spot that was concerning the patient.
The pattern is skin coloured clods with looped blood vessels and white lines.
This is a typical Seborrheic Keratosis
This lesion was found on a general examination of a 71 yr old gentleman. Features that make it likely to be a BCC are the serpentine blood vessels, the white lines and the dark pigment clods
Histology - Macronodular Basal Cell Carcinoma
Same man and another lesion likely to be a BCC. A good example of the white lines commonly seen in a BCC. Histology - Superficial Basal Cell Carcinoma BCC
This lesion has been growing for many months. Clinically it is has a defined raised margin and the blood vessels are what you see in a BCC. Incision was from the edge of the nose into the lip margin
Histology - Basal Cell Carcinoma BCC invading dermis - completely excised
One week post op. The swelling of the lip is related to her chewing her lip while the anaesthetic was still working
Elderly gentleman has had this lesion on his right chest for 3 years. It is 3 cm in diameter, raised, ulcerated and has serpentine and branched blood vessels. Likely to be a BCC
Histology - Macronodular Basal Cell Carcinoma
Another elderly gentleman with an "ugly duckling" lesion on the right shoulder. The pattern at 10 o'clock is reticular ( an important comment because the new lesion has arisen in a solar lentigo and this narrows down the Dx ). The rest of the lesion has no specific pattern so it is termed chaotic. The important area to look at is between 6 and 7 o'clock where there is grey pigment ( ie in the dermis) and means that a Melanoma has to be included in the differential diagnosis.
Histology - Melanoma in situ
This lesion is on the arm of an elderly lady. It appeared two weeks ago and grew rapidly. It has a central keratin plug and the blood vessels are spiral and looped in response the stretching effect the rapid growth has on them. This is most likely to be a Keratoacanthoma. The differential diagnosis is with an SCC. A diagnosis is important so the options are to remove completely or to shave the top for histology and curette and cauterize the base. Histology - Unable to differentiate between a Keratoacanthoma and a Squamous Cell Carcinoma - this type of report is common for these lesions and means that if it has not been removed completely , it needs to be watched very closely.
Anyone who is enthused by looking at skin lesions is welcome on this blog. My aim is that we all learn from each other.