Case discussion: How would you treat this patient? [3 May]
Case submitted by Dr D. Carragher
A 72 year old man who was an outdoor worker has regular skin checks. He presented last week with this lesion which had been there for 40 plus years and said it had changed recently.
Do you think this lesion is suspicious of benign? Why?
Here is the dermoscopy image. Using the 3 point checklist, how would you describe this? And, what is your preferred diagnosis?
How would you biopsy this lesion and why?
Ant chest – Ellipse of skin measuring 31x14x9mm with a variegated pigmented plaque measuring 17x13mm 6PALE 28 2L
Sections show an irritated, broad based moderately atypical compound melanocytic naevus with marked pigment incontinence. Margins appear clear. Deep margin: 3~m
Peripheral margin: 0.5mm
In the centre the dermal component is regressing. Overlying in area, there is a continuous lentiginous melanocytic proliferation with some Pagetoid spread, consistent with melanoma in situ. Margins appear clear.
Deep margin: 5mm
Peripheral margin: 2mm
1. ANTERIOR CHEST: MELANOMA IN SITU ARISING IN REGRESSING MODERATELY ATYPICAL COMPOUND MELANOCYTIC NAEVUS.
Prev SCC positive margins.
Pot l:Right leg lesion: Skin ellipse 35x30x5mm with a central dark brown crusty nodule 24x20x2mm. Staple R superior, on form states staple R proximal. (A-Ex2ts. vg.r.i . jg)
Sections show skin with a well differentiated squamous cell carcinoma. The dermis shows solar elastosis. No vascular or perineural invasion
is seen. Granulation tissue and scar are also seen.
Excision skin right leg: Squamous cell carcinoma, margins clear.
Please share your thoughts in the comment section below. Professor David Wilkinson will provide his opinion and advice.