How Much Do You Trust Your Doctor ?
A middle age gentleman attended the clinic for an initial skin check, on examination we found a number of skin cancers that needed to be removed. However, the most interesting find was a pigmented lesion to his left ear lobe. When we question the patient about this lesion, he seemed to think that it had been there for around a year but could not say for sure.
We examined the lesion which was affecting a wide area of the ear lobe under the dermascope, which showed gross features of a simple age or sun spot, however it also showed a pigment pattern around some of the hair follicles consistent with a possible melanoma presentation.
Ideally speaking when dealing with a pigmented skin lesion the whole lesion should have been excised and sent away to pathology for closer examination. In this case excision the whole lesion would have meant removing the patient entire ear lobe. Therefore, we decided to removed only part of the lesion and wait for the pathology results.
When the pathology result came back in it was a pleasant surprise with result confirming that it was a simple age spot. This is where the real challenge with our job / role lies, are we still missing something such as a more serious underlying diagnosis.
What do we do in this situation?
After a follow up consultation with our patient we gave him all the options about treatment and the pathology results. This patient decided to leave it up to our team to decided what we thought was the best course of action. From this we decided a full excision of the lesion was the safest option, informing the patient that the final diagnosis would most likely not change and that cosmetically we would do our best to ensure a good outcome.
Fortunately our decision to remove the whole lesion was the best decision we would have made as the final pathology came back and confirmed a Melanoma was hidden under the age spot on his ear. A full ear lobe reconstruction using skin from behind his ear was performed at our Ellenbrook location. In the months to come the cosmetic result will be outstanding.
Skin Cancer Versus Normal Aging
This very pleasant gentleman which attended our clinic for skin check could not believe he has cancerous changes just above his eye. Even in the picture it seems just like a bit of denting on an aged skin.
This lesion is confirmed to be a Basal cell carcinoma with deep penetration in to the skin however fortunately hadn't reach the critical tissues like the nerves.
Can You Find The Hiding Melanoma ?
Not uncommonly finding a melanoma can be quite challenging. In particular in people with too many moles ( more than 100 moles ) on their body. On the other hand, having more moles increases the risk of melanoma.
Small melanomas can be easily missed by even an expert physician. It is better to check such patients in at least 2 separate visits to reduce the risk of missing cancerous lesions. It's important to add that in many cases the person carries more than one malignant lesion. In this case we found 4 melanomas in different parts of the body.
The 3d photo shows the surgical wound for the removed melanoma . The last photo is around 3 months later when the patient is back for a follow up skin check.
Malignant Melanoma On The Shoulder
This patient presented to the clinic for a skin check as his daughter was concerned about the mole on his right shoulder blade. In particular she has noticed the mole was growing bigger and asked her father to come and check it. The pathology came back on this mole as a Malignant Melanoma Clark level III.