Tuesday, January 10, 2006

Rapidly Growing Tumor

This 70 yo man presented on January 9, 2006 with a three to four month history of a lesion on his upper back. It was noticed by his wife. He has type III skin and a past history of renal cell carcinoma.



An excisional biopsy was performed.

Presumptive diagnosis is melanoma, probably nodular type.
Pigmented basal cell is another possibility, but rapid growth favors melanoma.
I do not think metastatic renal cell carcinoma would be pigmented.

January 25, 2006 -- Update
The biopsy showed a superficial spreading melanoma, 2.04 mm thick, Level IV.
The patient underwent a wide local excision with 2 cm margins. He elected not to have sentinal node biopsy.

4 comments:

  1. This comment has been removed by a blog administrator.

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  2. I agree completely with your differential. I've also seen an infarcted/infarcting hemangioma look like this.

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  3. My question: is the covering discoloration of the tht nodule a real pigmentary or just blackish crusting??If it is crusting,I would consider the possibility of keratoacanthoma.Here the management will be much easier.Biopsy will cofirm that.

    khalifa sharquie

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  4. It smells something malignant and i vote for melanoma. Regarding the pigmentation (as you mentioned) a metastatic renal cell carcinoma is a less probability...besides, i think upper back is not a usual site for metastasis of renal origin. I beleive that dermatoscopy could be helpful in this situation. Thanks for sharing, Omid

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