Diabetic male, 76 years old, black skin, in peritoneal dialysis, main complaint of a non-healing foot ulcer. During examination, I found this single lesion on the the scalp by chance. Dermoscopy features of SCC: white circles, white structureless zones (keratin), blood spots. What's the best management for this specific patient? Is surgical excision safe? Shall I refer to radiotherapy instead of operating him?
Noduloulcerative lesion ,seems to be on the scalp and as you said in an elderly patient- Few things need to be done
1 FNAC, Bx for Histopathological confirmation of grade and type of Squamous cell carcinoma
2 Evaluation for local metastases to the regional lymphnodes- CT Neck and head
3 In view of comorbidities - xcision/ 5-FU/ Immiquammod topically
Thanks Dr Mendiratta, but I'm afraid wound will not heal properly, that's why I'm thinking about radiotherapy instead. I have never read about 5-FU and imiquimod as adjuvants for SCC, do you have the references?
It does not look like a big lesion, even with comorbidities surgery may be easiest to do. Or maybe I can not appreciate size on the picture
Definitely surgical excision after biopsy histological confirmation and skin graft\flap repair. A dermal template would also be a good choice to keep surgical times short.
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