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Case 215

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Male 52 years old dark-skinned patient attended to the Dermatology outbuilding of Hospital das Clínicas with the report of the appearance of a “spot” in his abdomen, which he believed had grown over the course of the last months. He was unable to specify when the injury had appeared and reported itching and a few episodes of local bleeding. It was then held the Dermatoscopy.

Considering the clinical history and images, which is the most likely diagnosis?

a) Blue Nevus

25%

b) Melanoma

25%

c) Basal-cell Carcinoma

25%

d) Common melanocytic nevus

25%
   

Image analysis

Image 1: Photograph showing a blackened papule, with a mamilonada surface , precise limits , jagged edges and measuring approximately 1 cm in its longest axis .

 

Image 2: Dermoscopy showing that the lesion presents gray-blue ovoid nests in its periphery, with leaf-like areas (red line) .

Highlights

- Basal cell carcinoma (BCC) is the most prevalent skin cancer in the world and less aggressive one, as it does not generate metastasis;

- Its most common clinical presentation is the nodular ulcerative type. The pigmented type is part of the differential diagnosis of benign lesions such as common melanocytic nevi and malignancies, such as melanoma;

- Dermoscopy is a method that assists in the diagnosis, especially of pigmented lesions, allowing visualization of morphological features not visible to the naked eye.

-Under dermoscopy , the CBC appears as a blue lesion with ovoid nuclei in the periphery;

- The treatment for CBC depends on the characteristics of the injury , and excision with safety margins still the best therapeutic option . 

References

- AZULAY, R.D.; AZULAY, D.R. Dermatologia. 5. ed. Rio de Janeiro: Guanabara Koogan, 2008. 984p

- REZZE, G. G et al. Dermatoscopia: o método de análise de padrões. AnBrasDermatol. 2006;(3):261-8

- Savassi-Rocha P. R., Sanches SRA, Savassi-Rocha AL. Cirurgia de ambulatório. Medbook, Rio de Janeiro, 2013.

- TERZIAN, L. R. Carcinoma Basocelular. Disponível em: www.mohs.com.br

- CHINEM, V. P., MIOR, H. A. Epidemiologia do carcinoma basocelular. AnBrasDermatol. 2011;86(2):292-305. Disponível em: http://www.scielo.br/pdf/abd/v86n2/v86n2a13.pdf - Acesso em 06 de janeiro de 2015.

Authors

Daniela de Souza Braga, 6th year medical student at UFMG

E-mail: danibragamed[at]gmail.com

 

Flávya Letícia Teodoro dos Santos, 6th year medical student at UFMG

E-mail: flavyateodoro[at]gmail.com

 

Ana Cláudia Leão, 6th year medical student at UFMG

E-mail: aclaudialeao16[at]gmail.com

Supervisor

Flávia Vasques Bittencourt, Professor of Dermatology–UFMG

E-mail: flaviavbi[at]gmail.com

Reviewers

Luísa Bernardino, André Guimarães, Gustavo Campos, Bárbara Queiroz, Fernando Bottega, Cairo Mendes and Professor Viviane Parisotto

Translated by

Rafael Fusaro Aguiar Oliveira, 5th year medical student at UFMG.

E-mail: rafusaro[at]hotmail.com

 

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