Case discussion: How would you treat this patient? [9 May]
A 60 year old woman presents for routine skin exam.
Do you see any suspicious lesions on this woman’s back?
This lesion was considered suspicious and here is the dermoscopic image. How would you evaluate this, and what action would you take?
No action was taken at this time, and here is the clinical image and dermoscopic image taken 2 years later (she missed her 12 months skin check). How do you evaluate the situation now?
How would you biopsy this lesion?
Here is the pathology result:
Excision. Upper back 12x10mm pink structureless macule with eccentric brown with lines reticular. Changed on digital review. ?Melanoma.
Sections show skin to subcutis. There is a nested, lentiginous and focally confluent proliferation of variably atypical melanocytes at the dermoepidermal junction. There is focal extension of atypical melanocytes along follicular structures and upward scatter of atypical melanocytes into the upper layers of the epidermis is seen focally. The superficial dermis shows a mild to moderate chronic inflammatory cell infiltrate with melanin pigment incontinence and concentric eosinophilic fibroplasia. There is no evidence of invasive malignancy. Atypical melanocytes come to 2.1mm from the closest transverse margin. The lesion is well clear of deep margin. It is excised in the planes of sectioning.
UPPER BACK – MELANOMA IN SITU, SUPERFICIAL SPREADING TYPE (CLARK LEVEL 1) WITH FEATURES OF REGRESSION, 2.1mm FROM THE CLOSEST TRANSVERSE MARGIN.
Please share your thoughts in the comment section below. Professor David Wilkinson will provide his opinion and advice.