|Skin Cancer Doctors Ltd - Whangarei||
76 yr old man with a spot on his scalp. Central dark pigment clods surrounded by a reticular network and sharply demarcated scalloped edges. This is a Solar Lentigo commonly called an Ink Spot Nevus
83 yr old man has spent a lot of time outdoors. This ulcerating lesion has serpentine blood vessels and the white spots represent sclerotic fibrous tissue. This is likely to be a Basal Cell Carcinoma of the sclerosing subtype
71 yr old man with a Seborrheic Keratosis. These are of no concern
This teddy bear is on a mans thigh and has been there a long time. You will notice that the pigment pattern is regular and because the pigment is brown and black it means it is only in the epidermis. This is a Congenital Nevus and is of no concern
Beware the persistent ulcer on a tongue. If this was present for longer than one month, it requires a punch biopsy because of the possibility of it being a squamous cell carcinoma
This lesion on the upper lip has been present for a few months and was examined with the dermatoscope and looks like it is just scar tissue. The picture below is of the same lesion without any pressure from the dermatoscope and you can see the blood vessels that allow the diagnosis to be made.
Lip Basal Cell Carcinoma
This lesion consists of skin coloured clods with central blood vessels with a uniform pattern. This has the features of a Seborrheic Keratosis. Old terminology describes this as a cobblestone appearance
This spot has a dark black clod centrally with a grey smudge around 9 o'clock. This is a piece of rusty steel under the skin
This beautiful flower shows central ulceration with surrounding white thickening related to keratinisation and is likely to be a Squamous cell carcinoma.
This 80 year old farmer came to see me for removal of a sebaceous cyst on his forehead. I asked him about the spot on his nose and he told me that it has been present for ten years and that he had been reassured by several people that it was okay. I seems to have grown more over the past three years. This is a melanoma and needs to be removed urgently.
Histology: Level 4 Malignant Melanoma
This is the Dermatoscopy image that shows all the classical features of a Melanoma. Chaos with blue/grey pigment clods on a background of thickened reticular lines and white lines that are seen in polarised dermatoscopy.
Another Dermoscopy picture taken through oil showing the chaos ulceration and radial lines
This picture shows an ulcerated area that is likely to be a squamous cell carcinoma. The area from the ulceration coming around to 8 o'clock is likely to be early SCC as well as there is a lot of scar tissue as well as unusual blood vessels. All of this that you see in the picture was removed and the skin next to the hair line was sutured to the pink/red tissue from inside the lip. This is an good procedure that is well tolerated with an excellent cosmetic result however some sensitivity will be lost from the lip.
Histology - Squamous Cell Carcinoma
79 year old man with a gretish patch on his neck
The central area in the picture is chaotic with radial lines and grey pigmentation being the main clues for a Melanoma.
Histology: Melanoma in situ
Marking the incision on the top of the 67 yr olds ear to ensure complete removal of the Basal Cell Carcinoma. The ear is being held forward by the assistants finger that you can see.
The graft was harvested from the neck behind the lower part of the ear. Most of the fat is removed from the graft using curved scissors. The graft needs to have some holes in it to prevent blood collecting under it. The blood would separate the graft from its nutrient source and then the graft would fail.
The graft needs pressure on it to make it heal well so the vaseline gauze is tied in place and needs to stay there for at least three days.
Five days post graft
67 yr old male with annoying lesion on the back of his ear. This has a rolled edge and serpentine / arborising blood vessels. This is the typical appearance of a Basal Cell Carcinoma and will be removed and grafted.
55yr old male with an annoying spot on his ear that has been present for a few years. There was very little thickening around the edges however the central area was shiny and depressed. This was removed and a graft from the neck was placed in the defect.
Histology: Nodular Basal Cell Carcinoma
68 yr old lady with this mole on her iris that she has had all her life. This is the first time I have seen it. There is a reasonably consistent pattern of brown pigment close to the pupil and extending out to the periphery. The area of concern for me is around 9 o'clock. I will take another picture in 3/12 time to see if there has been any change. It is important that these lesions are followed as there is the possibility of a Melanoma forming within the nevus.
76 yr old lady with this lesion on her knee. Grey clods with white lines can be a concern as they can indicate a Melanoma. The history is so important here. This lady remembers falling onto gravel and injuring her knee and this appearance has been there ever since that episode. So the grey dots are gravel mixed with the white lines that are just scar tissue
This patient came for a second opinion as her GP was concerned about the lesion and wanted to remove it urgently. You will see serpentine blood vessels and the lesion has been growing over recent months. Dermatoscopy can make the decision difficult if you place a lot of emphasis on the blood vessels when in reality they are only a minor clue.
This is a young person who has not had a lot of sun exposure and the lesion has been present for a long time but have grown recently.
Examination shows terminal hairs growing from within the lesion and the lesion is smooth with no ulceration. It is reasonable to review these after three months to see whether there has been any change. It appears to be a Congenital Nevus.
Anyone who is enthused by looking at skin lesions is welcome on this blog. My aim is that we all learn from each other.