87 year old lady with a lesion on her left cheek that has been growing and becoming darker over recent months. She says that her GP did cryotherapy on it some time ago. Cryotherapy to a pigmented lesion is not recommended.
The pattern here is chaotic with thickened reticular lines centrally and moth eaten areas at 3 and 7 o'clock that have within them black dots, broken lines, grey dots and polygons. With these features the lesion must be treated as a lentigo maligna - ie a melanoma in situ on the face. Treatment options here are a shave biopsy of the entire lesion to confirm the nature of the lesion or complete excision. I have opted for complete excision and will post the histology when I get it.
Histology - Melanoma in Situ
The pattern here is chaotic with thickened reticular lines centrally and moth eaten areas at 3 and 7 o'clock that have within them black dots, broken lines, grey dots and polygons. With these features the lesion must be treated as a lentigo maligna - ie a melanoma in situ on the face. Treatment options here are a shave biopsy of the entire lesion to confirm the nature of the lesion or complete excision. I have opted for complete excision and will post the histology when I get it.
Histology - Melanoma in Situ
This lesion is on a 63 yr old lady. It started like an insect bite three weeks ago and has grown rapidly. The lesion is hard and very raised. It has a central ulceration containing a keratin plug and radial white lines with coiled, spiral and dot blood vessels. This is typical of a Keratoacanthoma however an SCC can behave in the same way so removal is a good choice
Histology - Squamous Cell Carcinoma
Histology - Squamous Cell Carcinoma
This lesion is on the chest of an old sailor. Nonpigmented lesions can be hard to differentiate however an ulcerated lesion that has branching vessels at 12 o'clock suggests a BCC.
This is a good example of Psoriasis that has been treated with steroid cream. Untreated psoriasis is likely to have a more erattic pattern of blood vessels covered by thick layers of scale.
Psoriatic nails showing the pitting that is characteristic of this condition
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