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1800 867 1390Case discussion: How would you treat this patient? [13 February]
Case discussion: A 79-year-old male presents for a regular skin check. He had multiple SCC and BCC removed from his body in the past. The skin check reveals a suspicious lesion on the back.
Please describe what you see. How you would biopsy this lesion?
Case submitted by Dr Slavko Doslo
Update:
What is your interpretation and what would you do next, if anything?
Please share your thoughts in the comment section below. Professor David Wilkinson will provide his opinion and advice.
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Clinically, there is a raised pigmented lesion which looks different to those in proximity to it. It has varying colours and an irregular border.
Dermoscopically, there are the clues to malignancy of a blue/grey structure, eccentric structureless area and white lines.
Should be excised with 2mm margins.
I agree with Anne Connell
The lesion is “Ugly duckling” on the back.
Dermatoscopy:
Asymmetry in colour & structure
Multicomponent global pattern
Irregular brown globules
Multiple colours, black, blue, white, milky red, different shades of brown
Eccentric structureless area.
Excision with 2mm margin to exclude melanoma.
Agreed with Sue. Ugly duckling appearance with Chaos present in term of structure and color.
Dermoscopically- Clues
1/ Eccentric structureless area with white lines.
2/ Blue spot with grey dots.
3/ a few black dots/clods
Inclined to proceed with 2-3mm margin excisional and go from report.
Chaos with different shades, multiple globals, grey area, unspecific pattern, skin sun damaged area, negative network, branching vessels, one terminal hair……maybe MM evolving in a normal nevi…excise for HP.
Chaos with different shades, multiple globals, grey area, unspecific pattern, skin sun damaged area, negative network, branching vessels, one polygones/ angulated line, one terminal hair……maybe MM evolving in a normal nevi…excise for HP.
lesion with lots of chaos, asymmetrical, irregular borders, variegated colors and different shades of brown with eccentric whitish structureless areas, atypical network. Excision biopsy with 2-3 mm margins to rule out Melanoma.
Most likely MM
ELIPTICAL EXCISION 5 mm margins
Partially pigmented lesion left posterior shoulder, that does not appear to ‘fit the pattern’.
Chaos evident with irregular colour and shape
Clues evident with blue back structures, eccentric structureless area, white lines, irregular network to the right on dermoscopy.
I would perform excisional biopsy with 2mm margins.
melanoma/ scar / blue white coloration
Pigmented lesion: dermoscopical findings: grey structure, brown clods, serpentine vessels,
DD: Melanoma/ BCC
plan
excision biopsy
I note the diagnosis is invasive and superficial spreading.
Could I seek clarification ?
IN SITU : means no depth ( lentigo maligna)
Superfiicial spreading : ?? can be up to 1mm or
is that just called Superficial spreading with an invasive component.?
What margin would be appropriate from the edge of the lesion or is it from the invasive component?
Thanks
Given Invasive with Clark level III,
1/ Referral to next level (specialist/tertiary) for wider excision + Sentinel node investigation with +/- further metastasis.
2/ I can do wider excision 10 -15mm normal margin with +/-flap but no expertise and resources for sentinel node.
This patient needs local wider excision with sentinel node biopsy for LN involvement
Result of excision biopsy was invasive superficial spreading melanoma.
Breslow thickness is 0.4mm. 0 mitosis, no ulceration + patient’s age –> no need for Sentinel Node Biopsy or any further investigations.
Next step is, definitive excision of the melanoma, I require 10mm safety margin from all directions around the scar, down to the SC fat under the skin. Closure of the wound will be, either direct closure or with a flap.