Case discussion: How would you treat this patient? [12 September]

This week we have a case submission from Dr Slavko Doslo who performed a full-body skin check on an older patient with sun damaged skin. He noted PSL on the side of foot. No history from patient.

How do you evaluate lesions in this site?

How would you proceed with this one?

Old Patiend diagnosis_160912 PSL noted_160912

Case submitted by Dr Slavko Doslo

UPDATE:

Here is the excision biopsy result. Comments? What next?

pathology-report_160912

Please share your thoughts in the comment section below. Professor David Wilkinson will provide his opinion and advice.


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8 comments on “Case discussion: How would you treat this patient? [12 September]

  1. A small darker area than the surroundings and some angulated lines…….probably i will short monitoring it.

  2. Given oldie and not much impressive clues Dermoscopically: monitor with recheck 6/12 time.

    Some statistics indicate acral area is high chance of melanoma, and if such gut feeling force arise, then 3-4mm punched biopsy and go from there.

  3. Hi all: The lesion in my view deserves a shave biopsy because of the following: a) asymmetry of colour, b) In hour 12 position there is small blue structure, and above it there is what looks like two pseudopods, c) I agree that there are polygonal structures in the form of well defined pigmented edges meeting at wide angles. There are two separated pigment spots about hour five that also look suspicious and I would make sure these come out with the biopsy specimen all in one single block. In general my approach is that once I find e suspect lesion I biopsy there and then rather than risking a patient that may not return. Unless there is some issue precluding a biopsy like patient declining consent. I would try to get some form of history like if the patient noticed the lesion before and if he did are there any changes.

  4. Very interesting path report. They couldn’t see malignant cells and yet called it in situ melanoma?.
    Could this be the patient’s “signature nevus”, are the those other pigmented lesions on the foot look exactly the same? I think if the lesion looked different from others, then I would have definitely done a punch biopsy.
    The question is if it is a melanoma, should it require a re-excision given lat margin <1mm?

    1. The HP reading is kind of strange i must say. How can u call it melanoma insitu and state no malignant cells seen….

      1. Good comment regarding “signature nevus”. I always check as additional reassurance for “signature nevus” , he has different nevus type elsewhere. I was happier with second report than with first report on which I reacted and asked for second opinion, For me is better to ” cut suspicious” than leave and miss. Any displastic nevus I remove by excision as I witnessed transformation to melanoma during follow up over 12 months. Some patients lose interest in follow up and than melanoma down the track can be problem ( that is why I started to take photos of any reported mole to me.

  5. notice for website; I posted my comment 09.05 AM on 15.09.2016. but I see it was on site September 14.2016. at 11.05 please synchronize the clock
    Thanks