Case discussion: How would you treat this patient? [29 January]

This week we have another interesting case discussion from Dr Slavko Doslo. An 88-year-old patient with past history of melanoma presented for skin check that revealed a suspicious lesion.

Describe what you see from the clinical and dermoscopy images. How would you biopsy this lesion?

slavko_doslo_230117_1 slavko_doslo_230117_2

Case submitted by Dr Slavko Doslo


What is your interpretation and what would you do next, if anything?

Slavko_Doslo_250117_1 Slavko_Doslo_250117_2


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? [29 January]

  1. The lesion appears as “the ugly duckling”, quite different from the rest on clinical image. Dermoscopically, the lesion looks asymmetrical with whitish structureless area, black dots/peppering and with different shades of brown, hence suspicious. I will perform excision biopsy with at least 2mm margin to rule out Melanoma.

  2. Clinical: variably pigmented slightly elevated skin lesion with irregular shape/border – background very sun-damaged aged skin.
    Dermoscopy: presence of blue-grey, eccentric structureless and white lines suffice to indicate excision biopsy with 2mm margins. Brown dots in lines present, so pigmented bowen’s as well as melanoma in my differential.

  3. Chaos with different structures and colours, showing orthogonal white lines, pigmented brown non specific networks, pink area, brown dots in groups (3 in numbers), all of which would imply excision with 2mm to exclude malignancy.

  4. This lesion certainly ‘breaks the pattern’ deserving more attention. On Dermoscopy Chaos of colour with white lines, [segmental] peripheral pigmentation, radial – blue grey structures as the most obvious clues, all pointing to possible Melanoma. In a history of previous Melanoma it leaves know option but to excise with 2mm margin and manage according the histopathology. Should the diagnosis be of a benign lesion it would prompt me to discus with Pathologist and ask for deeper sections in this case.

  5. Irregular shaped pigmented macule
    Dermoscopy: multicomponent: central irreg areas of hypopigmentation with overlying blue grey
    Irreg dots and blotches with a large area of regression. Asymmetry of colour and structure.
    Highly suspicious of a melanoma: warrants an excision biopsy: would proceed with a 2 mm clinical clearance excision biopsy

      1. Firstly the whole lesion os rather polygonal. Then on the right side right of the lesion you can make out a polygonal shape bordered by the pigment. The line are not discrete and that is more important in my experience.

  6. Reports are very confusing : one states lt forearm Nd another rt upper arm.
    Is this the same patient? 2 lesions? Is this the excision biopsy report or the report of the formal treatment excision?
    Please clarify

    1. Yes you are right, there mix in reports as I send 2 different melanomas excisions for same patient , one was excised 25.03.2011 left forearm what you see on photo and re excision 05.04.2011 ( report not included in file) , next was removed another lesion right upper arm 24.04.2011( you have report but not yet photos , sorry. ( on photo which I send to office you can see dates so can have chronological order. Maybe Dr Wilkinson wants to keep you on your toes to see how carefully you read reports. (ha ha ha )
      Thank you for noticing