Case discussion: How would you treat this patient? [31 October]

Great learning opportunity with a simple, real life and everyday scenario from Dr David Smith. A 69 year old gentleman attended for a skin check with a small pigmented lesion on the left lower leg that he was not aware of.

How would you evaluate these dermoscopy images?

david-smith-case_311016     david-smith-case_311016_2

Case submitted by Dr David Smith


How would you biopsy this lesion – if you chose to biopsy it?

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? [31 October]

  1. Chaos. Eccentric structureless area. Thick pigmented branching lines, peripheral pods. A polarised specific white line.

  2. chaos, with structures area, probable regression , thickened lines and some clods
    needs 2 mm excision for histol and further treatment if needed

  3. Irreg in shape:asymmetry colour and structure: irreg areas of regression; atypical network- thickened in places with irreg blotch and irreg dots.
    2mm clinical clearance excision biopsy is needed

  4. I think we are getting too clever, one has to get in first to make an original remark. I cannot fault the previous comment and would do likewise

  5. 1/ Evaluation of dermoscopy images?- Chaos + (asymmetry of structure and color). Clues+ (thick reticular and polygon especially in central, whitish stuff more marked in polarised pic).

    2/ Mx- size ??. (less or more than 5mm!). Easy to remove but how to manage the defect in lower leg with tense skin, which usually require graft or flaps. If the size is >5mm, you do 2mm margin excisional biopsy with flap or graft, and then if report back revealed melanoma, requiring further 5-10mm margin excision and again with 2nd flap or graft- not good practice. Thus wonder wide bore punched 2 places or shaved with deep dermal and go from there. If 5mm or <5mm – favoured excisional biopsy straight away. Of course Excisional biopsy is ideal for any suspicious pigmented lesion.

  6. Chaos with different shades and structure showing eccentric white structureless area, white lines, ? curved line at top/ ? thick line reticular, polymorphic vessels. sounds MM Need to cut with 5 – 1o mm margin.

  7. Asymmetrical, irregular borders, atypical network, thick reticular lines and whitish areas of regression. I would do biopsy first to get more definite diasgnosis.