Clinical images: Malignancy

Presentations and consequences of malignant disease. By Dr Philip Marazzi.

Squamous cell carcinoma

This man has a different form of skin cancer. He is a sailor and has spent much of his life outdoors. His lesion is more solid in nature. This is a squamous cell carcinoma. It was also surgically excised, with no further treatment required. The patient had intensive follow-up to ensure there was no recurrence of the condition.

Basal cell carcinoma

This patient presented with a lesion growing on his chest. It demonstrates the classic raised rolled edge seen with a basal cell carcinoma. It was surgically excised and no further action was required.

Malignant melanoma

The third type of skin cancer is shown here. Advice about sunburn still has only minimal success in reducing the desire to acquire a suntan and hence damage the skin. This lesion shows various characteristics which should always raise suspicion, the irregular shape and pigmentation being most obvious. These, coupled with the rapid change, made this an obvious diagnosis.

Carcinoma of the larynx

This elderly man presented with intermittent hoarseness over three months. He was referred to ENT and laryngoscopy revealed a squamous cell carcinoma of the vocal cord. He had radical radiotherapy over six weeks and has done very well. The immediate period following his radiotherapy was difficult, but he got through it and has had no problems for two years.

Carcinoma of the breast

This 59-year-old woman presented with locally advanced and metastatic breast cancer. Sadly, she had ignored her disease for many months. She was started on letrozole, but the HER2 status of the tumour was unclear. Some months later, she was started on trastuzumab and chemotherapy. After six cycles, her chemotherapy was changed again. After two years, she decided to stop all treatment. She died within a few weeks.

Non-Hodgkin's lymphoma

This 82-year-old man presented with cervical lymphadenopathy. Chest X-ray also revealed some mediastinal lymphadenopathy. A biopsy confirmed low-grade lymphoma. He had chemotherapy and, four years later, remains well with no sign of recurrence.

Carcinoma of sigmoid colon with ascites

This man was a heavy drinker and put his change in bowel habit and swollen abdomen down to his drinking habits. He finally presented and was found to have ascites secondary to a carcinoma of the sigmoid colon. He had surgery for symptom control and followed this with some palliative chemotherapy, but died six months later.

Transitional cell carcinoma of the bladder

This previously fit 88-year-old man was diagnosed with transitional cell carcinoma of the bladder. He went into hospital for a cystectomy due to severe persistent haematuria from a recurrence, but unfortunately, during the operation, his bowel was perforated. He required a defunctioning colostomy as well as his cystectomy. Postoperatively, the patient’s recovery has been further complicated by a stroke.

  • Dr Marazzi is a GP in East Horsley, Surrey.

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