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1800 867 1390Case discussion: How would you treat this patient? [13 March]
This week’s case discussion is another learning opportunity with a simple, real-life and every-day scenario from Dr Slavko Doslo. An 73-year-old male presented for a skin check with few spots on his back.
This is not a stand-out lesion clinically. On dermoscopy, what makes you suspicious?
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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1300 856 695
+44 203 514 0688
1800 867 1390
It scores 3, asymmetrical, atypical network and white-blue – 2 mm margin excisional biopsy
Dermoscopically:
1/ Irregular network with thick reticular at 2 or 3 places
2/ central pale pinkish structureless
3/ white-bluish just above pink area
Thus 2-3 mm margin excisional biopsy and go from there.
Chaos showing a hair emerging, and multiple thick lines reticular in irregular patterns, and eccentric pinkish area with some grey would mandate excision to rule out MM developing in a congenital nevi.
PSL; Chaotic with multiple colours; brown, red and a central grey area with clues involving grey and structureless area in the middle extending laterally to 10 o’clock boundary. There is a bit of thick network on left but I can’t call it abnormal network if it was standing alone.
Dx; SSM
An Excisional biopsy with 2 mm margins to confirm the diagnosis can be performed.
a rectangular lesion macroscopically, dermatoscopically showing Multiple colours, regression in the center, thick assymetricaly distributed reticular patterns, black dots towards periphery
Needs wide excision with 2mm margins
provisional Dx- Superficial spreading Melanoma or a Severely dysplastic nevus
Lesion shows asymmetry in colour. The network a bit irregular upper left. Pink area in centre ? due to irritation. Some white spots ?Keratinisation. It may bean irritated /ulcerated lesion. ??Blue area which may suggest a MM. D?D Irritated SCC.
atypical network with patches thick and thin reticular pattern and angulate/polygonal lines
colours multi
blue clod centre
serpentine blood vessels centre
white lines or inverse network at 10 o’clock
suspicious of melanoma
Asymmetry in color and structure
Multi component global pattern
Atypical network
Area of regression
More than 5 colors
Shave biopsy ASAP to exclude melanoma
Asymmetry, atypical network, variegated colors, irregular borders- excision with at least 2-3 mm margins to rule out Melanoma
To response to “what would you do next, if anything?” Based on pathohisto report: Excision size 35x16x6mm and lesion 8x7mm. If practitioner excised initially with 5-10mm margin, then watchful f/u. But the lesion width 7mm is just slightly short in calculation with excised part 16mm width. Nevertheless, Skin can shrinkage after excision and cannot rely on histo size. Thus let’s us ask doct for his excised margin. 🙂
Thanks for Q, I removed more than 5 mm on each side ( pathologist at time explained that we have shrinkage due to muscle retraction plus retraction of sample due to used chemicals for preparation for microscopy) 35x15x6 mm sample , 6,5 y follow up did not show any recurrence of cancer
Many thanks.
Next step would be a wider excision margin is needed as it is recommended 5 mm excision margin for Melanoma in situ unless it was originally excised with that margin clinically.