December 2014 | Case of the month - gain CPD points

1. What dermoscopic features can you see?

• The lesion is rather chaotic ie lacks symmetry
• Multiple blue-grey dots and globules
• Well-focused vessels, which can be described as branching ie arborising
• There are NO features of a melanocytic lesion

2. What is the diagnosis?

• A solid basal cell carcinoma (BCC)
• The diagnostic clues are:
  • The history of a slow-growing lesion. BCC grow at approximately 2-3 mm per year
  • The history of something that occasionally bleeds, crusts and then heals over
  • Dermoscopically there are blue-grey dots and globules consistent with a BCC, whereas brown / black dots and globules are seen in melanocytic lesions. The presence of well-defined branching vessels is also in keeping with a BCC
     

3. What is the management?

• The patient needs a thorough skin examination looking for further BCC, and other skin cancers
• Provide advice on self-examination and UV-protection
• The dermoscopic features of blue-grey dots and globules and / or arborising vessels informs us that this BCC is solid (ie nodular) as opposed to superficial. The lesion is therefore only suitable for treatment by excision, as opposed to topical treatment etc
• The patient should be referred to either a GPwSI in skin surgery, a plastic surgeon, or a dermatologist who undertakes skin surgery to a good level
• The lesion needs to be excised with a 4 mm clear margin and sent for histology

Of note:

• Refer to the chapters on BCC for more information
• Dermoscopy, in the right hands, is a very good tool that aids in the diagnosis of many benign skin lesions as well as BCC. To learn more about dermoscopy please refer to our educational events