Clinical cases
Stepwise, interactive cases drawn from real UK skin oncology practice. Work through the history, examination, dermoscopy, investigations and MDT decision. Each case reinforces specific learning points and references.
Melanoma
A changing pigmented lesion on the back
A 42-year-old with a 7 mm pigmented macule noticed by her partner. Work up the lesion, interpret the dermoscopy and plan the excision.
Slowly enlarging pigmented patch on the cheek
A 76-year-old farmer with a 3-year history of a brown patch on the cheek. Facial dermoscopy, mapping biopsy, staged excision and reconstruction.
Longitudinal melanonychia of the thumb
A 58-year-old with a widening pigmented band on the thumbnail. ABCDEF criteria, Hutchinson's sign, nail-matrix biopsy and digit-sparing surgery.
Asymmetric pigmented lesion on the sole
A 65-year-old (Fitzpatrick V) with a plantar pigmented lesion. Parallel-ridge dermoscopy, SLNB, plantar reconstruction and adjuvant pembrolizumab.
Rapidly growing pigmented nodule on the back
A 54-year-old tradesman with a 6-week dark nodule on the upper back. T4b nodular melanoma — AJCC 8, NICE NG14 margins, SLNB, adjuvant pembrolizumab for resected stage III disease (TA766).
Keratinocyte cancers
Non-healing ulcer of the lower lip
A 68-year-old smoker with a 6-month non-healing lip ulcer. Distinguish cSCC from chronic actinic cheilitis, risk-stratify with BWH, and plan reconstruction.
Pearly papule at the medial canthus
A 72-year-old with an H-zone BCC at the medial canthus. Mohs indications, canalicular preservation and glabellar transposition flap reconstruction.
Recurrent BCC of the nasal tip in a previously irradiated field
A 78-year-old with a recurrent infiltrative BCC 22 years after primary RT. Mohs, subunit principle and paramedian forehead flap reconstruction.
Locally advanced cSCC of the scalp with PNI
A 78-year-old with a 3 cm scalp cSCC and V1 numbness. BWH T3, MRI for perineural spread, MDT, adjuvant RT and cemiplimab (TA802) decision.
Rare and adnexal tumours
A rapidly growing scalp nodule
A 74-year-old man with a violaceous nodule on the vertex for 8 weeks. Build the differential and reach the diagnosis.
A ‘recurrent chalazion’ that will not resolve
A 70-year-old with a persistent eyelid nodule treated three times as chalazion. Pagetoid spread, Mohs, Muir-Torre screening and oculoplastic repair.
Slow-growing firm plaque on the shoulder
A 38-year-old plumber with a violaceous plaque on the trunk. CD34, COL1A1-PDGFB, slow Mohs vs 2–3 cm wide excision, imatinib for advanced disease.
Five years of ‘eczema’ that won’t clear
A 55-year-old with persistent patches on buttocks and inner thighs. Multiple deep biopsies, TCR clonality, TNMB staging and supraregional CTCL service.
Persistent patches misdiagnosed as eczema for five years
A 62-year-old with patches on a bathing-trunk distribution. Stage IB MF — supraregional CTCL service referral, skin-directed therapy, topical chlormethine (TA720).
Rapidly growing painless nodule over the parotid
A 79-year-old farmer with a violaceous parotid-region nodule. AEIOU, CK20 perinuclear-dot IHC, WLE + SLNB + adjuvant RT, avelumab (TA691) if disease recurs.
Special populations
Multiple lesions in a renal transplant recipient
A 55-year-old 8 years post renal transplant with multiple AKs and two cSCCs. Plan field and lesion-directed therapy and immunosuppression review.
Violaceous skin and oral lesions in newly diagnosed HIV
A 42-year-old with CD4 80 and disseminated KS. HHV-8 / LANA biopsy, ACTG staging, ART optimisation, KS-IRIS and pegylated liposomal doxorubicin.
Multiple cSCCs in a lung transplant recipient on voriconazole
A 65-year-old lung transplant recipient on long-term voriconazole prophylaxis. Antifungal switching, mTOR conversion, acitretin chemoprophylaxis.
Non-healing vulval ulcer in long-standing lichen sclerosus
A 64-year-old woman with vulval LS and a new ulcerated lesion. dVIN pathway, FIGO staging, gynae-oncology MDT, surgery + chemo-RT.
Grade 3 colitis on adjuvant pembrolizumab
A 60-year-old on adjuvant pembrolizumab for stage IIIB melanoma develops grade 3 colitis. ESMO irAE algorithm, methylprednisolone, infliximab, permanent ICI discontinuation.