September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 54-year-old lady presented with a solitary, sore, lesion on her right arm, which had grown relatively quickly over a period of 3-6 months. It bled only occasionally. There had been no history of trauma. The lady was skin type II and enjoyed her sunny holidays. There was no other relevant personal or family history.
A firm pink-red nodule with a central ulcer.
What is the differential diagnosis?
The differential diagnosis included an amelanotic melanoma, a poorly-differentiated SCC, and a Merkel cell tumour. The lesion was excised immediately in out-patients, histology showed a melanoma.
In terms of making sense of the diagnosis always beware of an 'EFG' ... E = elevated, F = firm, G = growth (persistent growth) lesion. All such lesions should be referred urgently as a 2-week wait. Although nodular melanomas may be brown/black, up to 50% are hypomelanotic and are pink-red, and occasionally skin-coloured.
In terms of what this is NOT. It is not benign, and it is not a BCC, which grow at an approximate rate of 2 mm per year. It is also not a pyogenic granuloma, which bleed profusely and are most commonly seen on the digits.
For more information refer to the chapter on melanoma.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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