Mole Management Strategy
The patient presents with a suspicious pigmented lesion ($1 \times 1$ cm, flat, scaly, itchy, black mole) on the thigh. The absence of inguinal lymphadenopathy is noted.
Choosing the Best Biopsy Method
For a suspicious skin lesion like this, the primary goal is to obtain a definitive histological diagnosis while also removing the lesion.
- Excision biopsy is the most appropriate management. It involves completely removing the lesion with a small margin of normal skin, allowing for thorough histopathological examination. This provides the best chance for accurate diagnosis and simultaneous treatment if the lesion is malignant.
Evaluating Other Management Options
The other options are less suitable for the initial management of this suspicious mole:
- FNAC of lesion: Fine Needle Aspiration Cytology is typically used for diagnosing enlarged lymph nodes or deep-seated masses, not for surface skin lesions where architectural details are crucial for diagnosis (like melanoma).
- Incision biopsy: This involves removing only a portion of the lesion. While sometimes used for very large lesions or in specific locations, it can compromise diagnostic accuracy compared to complete excision, especially for potentially changing lesions like this mole.
- Wide excision with inguinal lymphadenectomy: This is a more aggressive surgical procedure reserved for confirmed invasive melanomas, typically based on the depth of the tumor and/or the presence of lymph node involvement. Since lymphadenopathy is absent and the diagnosis is not yet confirmed, this step is premature.
Therefore, a complete excision biopsy is the recommended initial step for diagnosis and treatment planning.
Important Questions from Tumours
Which types of cancer are associated with exposure to ionizing radiation?
1. Leukaemia
2. Lung cancer
3. Breast cancer
4. Lymphoma
Select the correct answer using the code given below.
Which of the following are correct regarding Li-Fraumeni syndrome?
1. It has autosomal dominant inheritance and is associated with P53 gene.
2. It has autosomal recessive inheritance and is associated with P53 gene.
3. It is associated with an increased risk of sarcomas and leukaemia.
4. It is associated with an increased risk of brain tumours and osteo- sarcomas.
Select the answer using the code given below.
- A 25 year old female patient with previous history of neck irradiation presents with thyroid swelling for last 6 months. The patient is clinically euthyroid. On examination, the right lobe of thyroid gland is enlarged with presence of ipsilateral cervical lymphadenopathy. The most probable clinical diagnosis in this patient is
Which of the following statements regarding Carcinoid tumour are correct?
1. Terminal ileum is the most common site for these tumours in the gastrointestinal tract
2. These tumors arise from Kulchitsky cells situated at the base of intestinal crypts
3. 5-Hydroxytryptamine is the most common vasoactive peptide produced by these tumors
4. Serum chromogranin A is a useful marker for disease recurrence
Select the correct answer using the code given below :
- Which one of the following is correct regarding Gastrointestinal Stromal Tumour (GIST)?
