Case discussion: How would you treat this patient? [10 October]

While performing a skin check on an elderly person, Dr Slavko Doslo noticed a large, flat, pigmented lesion.

Would you have done anything with this?

What do you think of the dermoscopy images?

Pigmented Lesion_161010     Derposcopy 2_161010

Derposcopy 1_161010

Case submitted by Dr Slavko Doslo

UPDATE:

A very interesting result! Thoughts? What next?

pathology-report

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


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10 comments on “Case discussion: How would you treat this patient? [10 October]

  1. This is a diffuse variably pigmented lesion.
    I can see some polygons with regression and varying perifollicular pigmentation
    DDx is lentigo maligna & solar lentigo
    Shave biopsy as much of lesion or x2 of suspicious areas

  2. Overall sun damaged pigmented lesion (Solar lentigo). However 3 areas of interest dermoscopically:
    1/ grey dots in central part of 1st dermoscopic pic, (=R side, 2 o’clock in 2nd dermoscopic pic)
    2/ thick reticular and polygones in below of number 1 (=R side, 4 o’clock in 2nd dermoscopic)
    3/ polygones Left inferolaterally (=7-8 o’clock in 2nd dermoscopic pic)
    Plus eccentric strutureless pale throughout (?sun-damaged/regression)

    punch biopsy is a bit risk of missing Dx unless wide-bore in 2 or 3 areas. Thus shaved biopsy would be reasonable and go from there.

  3. large pigmented chaotic lesion on chronically sun damaged arm in an older bloke.
    Shave biopsy of whole lesion.
    This could be a lentiginous melanoma, often so slow growing that the patient doesn’t notice. May have been there for years.

  4. a flat big pigmented lesion showing Subtle angulated lines at top part with subtle grey area and lower part show line curved and perifollicular pigmentation…I think its collision between LM and SL

  5. The second slide shows polygons and some red clods and and some red things though not clear enough on this lovely magnifications, but sounds vessels….LM

  6. Superficial spreading melanoma, level 1.
    Excise with 5mm clinical margins.
    This is quite a large lesion so it will require either a flap repair or skin graft.

  7. Another nice pick
    It looks you did an ellipse with a 2mm margin which is very reasonable considering it was suspicious
    Considering pathology report I think you just need to take another 3mm of the scar margins now