Case discussion: How would you treat this patient? [28 November]

This week we have an interesting case from Dr Tamana Zemaryalai. An 18-month-old girl presents with a changing birth mark on her left thigh. The mother noticed an area of depigmentation and approached the doctor for a review.

What is your assessment? How would you handle this?

tamana_281116_1 tamana_281116_2

Case submitted by Dr Tamana Zemaryalai

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


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9 comments on “Case discussion: How would you treat this patient? [28 November]

  1. This is Congenital Melanocytic Naevus of moderate size
    The risk of developing melanoma in a single moderate sized naevus is very low
    The risks of any surgical intervention has to be balanced in such a small child
    It would be appreciated if dermoscopic images are posted at the same time to avoid guessing just on macro pictures
    In this case dermoscopy is vital to evaluate & plan further management

  2. It looked a large brown pigmentation 3cm x 2cm with asymmetric in shape and border. Given the age, likely D/Dx: congenital melanocytic naevus, regressed haemangioma (if Hx of haemangioma), birth mark.

    It is a medium/moderate sized and would be nice to have dermoscopic pic to appreciate the pattern. Although most of them disappear with growing age, there is a small risk of developing into melanoma and careful f/u with picture taken and comparison is paramount. I’d rather leave at specialist hand (referred), being a primary care practitioner. 🙂

  3. clinically, it looks benign congenital nevus- pretty symmetrical but will be interesting to see the dermoscopic image.

  4. Looks fine by me as its symmetrical with subtle darker one at lower left pole, however i would vote for congenital melanocytic naevus, and would appreciate having a dermatoscope image to decide and take it from there, Also it would be wise to follow it up shortly (3 months).

  5. Benign lesion. Don’t think if dermoscopy would be appropriate on such larg lesion. I would say leave it and reassure parents

  6. Given the age, unless there is other symptoms or signs to suggest this could be part of a congenital syndrome or paediatric disease, observing cautiously should be enough.