Case discussion: How would you treat this patient? [20 March]

Case discussion for this week: A 54-year-old patient presented for a skin check with concern about this mole on his anterior chest.

Please describe what you see from the clinical and dermoscopy images. Is it Seb k or Melanoma?  Why?

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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8 comments on “Case discussion: How would you treat this patient? [20 March]

  1. chaotic lesion with regression in more than 50 percent of the lesion,multiple colours, stand out single lesion, white lines, pigmented blotch in lower half and grey dots. consistent with a severely dysplastic nevus or melanoma

  2. Dermoscopically:
    Chaos + in structure and colour.
    Clues+ 1/ whitish and grayish, dots and clods on L side (9′ o clock), 2/ eccentric structureless/pinkish centrally, 3/ slightly thick reticular lines top (bet 1′ o clock) > pointing to Melanoma (regressing) .

    if Seb K: usually raised lesion, multiple orange and white clods, +/-flakes,

  3. significant asymmetry, chaos, different colors, thick reticulated lines, blotches and pinkish structureless areas; rule out Melanoma by excision biopsy with 2-3 mm margins

  4. pattern: reticulated lines, structureless centre, peripheral dots 6 o’clock – 9 o’clock, thick reticulated patter at 1 o’oclock
    colour: browns, grey, pink
    =chaos
    clues:
    thick reticulated patter 1 o’clock’grey structures, dots grey or black periphery
    = melanoma needs to be excluded – excision with 2-3mm margins

  5. Chaotic pigmented skin lesion showing segmental thick line reticular at top right, polymorphic vessels, black grey dots and clods, white orthogonal lines, blue white veil, area of whitish regression. MM

  6. chaotic in appearance, blue white veils at one end, pink structureless area in centre ,reticular lines at the periphery ? Severely dysplastic nevus/melanoma in situ. Needs full excision with probably 3mm all around.