Case discussion: How would you treat this patient? [5 March]

This week we have another interesting case discussion from Dr Slavko Doslo. A 62-year-old patient presents for a chest examination which reveals a suspicious lesion, incidentally.

Please describe what you see from the clinical and dermoscopy images. 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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9 comments on “Case discussion: How would you treat this patient? [5 March]

  1. Clinically: raised (nodular) papular erythema with central reddish dark, asymmetric color and structure
    Dermoscopically: telengectasia inferiorly (new v/s indicating to ?BCC), abnormal pigmented dots, clods and pods (?melanoma).
    Suggest with 2-3mm margin excisional biopsy and go from there.

  2. this lesion is a globular nevus, only needs 4 monthly monitoring to exclude changes, it has no dermoscopic concerning features to warrant a biopsy at this stage

  3. I agree with most. comments: clinically a standout lesion – clearly an ‘ugly ducking’. Dermoscopy only makes me more nervous – nothing to say this is benign. It is asymmetrical, there is white scar-ice depigmentation. Needs excision biopsy.

  4. It is indeed an extremely atypical lesion, I would not have biopsied this so early, infact I would have monitored it over 4-12 months and if changes were still present to warrant biopsy, I would have, THERE WERE ABSOLUTELY NO SIGNIFICANT DERMOSCOPIC FEATURES TO WARRANT A BIOPSY, it looks like a benign globular nevus but well done in doing the biopsy I would say and an even bigger congratulations to the Pathologist to diagnose such an early lesion which would otherwise show very little features to suggest malignant growth patterns. This would fall under one of the dermoscopic lesions which needs to be monitored to be biopsied after it shows changes of assymetric growth

  5. I agree with that. I may not have immediately biopsied this lesion.
    I did not find the dermoscopy compelling , I would like to think I would have eventually biopsied or I would have asked for a review. ( mostly on macro)
    I would have been wondering if it was like a the nearby Seb K that had been partially falling off rubbed off.
    Should I have found the dermoscopy clearly abnormal ?

  6. I would argue that the clinical appearance is “suspicious”. That is, we cannot say that it is benign, confidently. Yes, it could be benign, but we can’t be sure, at all. Dermoscopy does nothing to help make a benign diagnosis. Indeed as I said above the score is 2/3=suspicious. This is important, and there is no place for monitoring of lesions that look like this