Dr. Deepti Shukla
Venereology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I need an assessment for suspected moles in a person who had basal cell carcinoma and is removed by excision. After a month, a red spot was seen beside the excision area. First, it was flat and red, later turning to light pink and swelling. The two moles are on the scalp. It was smaller in size and changed in size and shape over time. The case also shows some symptoms like confusion, memory problems, and cognitive changes. The patient has diabetes and had heart surgery a few years back, and he is on medication. He is currently taking medications like tablet Nitromax (Nitroglycerin) 5 mg, tablet Ator (Atorvastatin) 10 mg, tablet Capoten (Captopril) 25 mg, tablet Examide (Torsemide) 10 mg, tablet Cidophage (Metformin Hydrochloride) 500 mg, tablet Dapagliflozin 10 mg, tablet Plavix (Clopidogrel), and tablet Aggrenox (Aspirin and Dipyridamol). I would like to have your opinion on the moles and red spot area beside the excision area. Please help. Thank you.
Hello,
Welcome to icliniq.com.
It could be a recurrence of basal cell carcinoma as margins may not have been excised. Therefore, it needs examination with dermoscopy to make a definitive diagnosis. If moles change in size and color or spread, that means it is becoming malignant. Therefore, it also needs to be examined by dermoscopy. See that swelling at the place of previous basal cell carcinoma could be a granuloma also after surgery. You can either do a dermoscopy or repeat biopsy to make a definitive diagnosis. The moles look malignant in the picture (attachment removed to protect the patient's identity). Also, all warning signs of malignancy like changes in color, shape, and irregularities in the margin are present in this case. Also, as the patient is underweight, that might indicate malignancy. Therefore, a biopsy needs to be done for moles. Also, what is the age of the patient? Thanks and regards.
Patient's Query
Hi doctor,
Thank you so much for your reply. The patient is almost 65 years old. I have some questions, please. Do I need to go to an oncologist or a dermatologist regarding the dermoscopy, and should he undergo a full body check? Do you not recommend a partial biopsy for the moles first; instead, do full excision and pathology? Honestly, we prefer to stay away from partial biopsies due to his health condition. What about metastasis? Did you check the X-rays and ultrasound? Do I need to do another type of X-rays that you recommend on other parts? You mentioned the margins might not have been adequately removed, leaving traces, and the pathology report shows some margin measurements taken. Do you think it is inadequate? With the patient's health condition, moles sizes, and the location on the scalp, do you think the excision is feasible? Are there any other therapy options? Thank you.
Hello,
Welcome back to icliniq.com.
You can go to a dermatologist who is a skin cancer specialist for dermoscopy. Basal cell carcinoma has a very rare chance of metastasis. So chances of metastasis to the brain are very less. But as the patient has symptoms, a neurological examination is essential. Regarding basal cell carcinoma excision margin, reports show it was excised completely, but chances of recurrence are always there, so we cannot rule out that. Regarding moles, I suggest you go for a small punch biopsy, including margins, as the patient's health is not good. Dermatoscopy done by a cancer specialist is a better way, for now, to see if any signs of malignancies are there. If dermoscopy reveals anything, go for a biopsy to make a definitive diagnosis. Thanks and regards.
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Venereology
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