Case discussion: How would you treat this patient? [3 April]

This week we have a case discussion from Dr Tim Aung. An 89-year-old male with a history of melanoma presents for a regular skin check.  During the skin examination the doctor noted a lesion on the mid-upper chest of his patient.

What is your evaluation, clinically and dermoscopically? What are your next steps?

     

Case submitted by Dr Tim Aung

Update:

Result: Seborrheic Keratosis

Please share your thoughts in the comment section below. Professor David Wilkinson will provide his opinion and advice.


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6 comments on “Case discussion: How would you treat this patient? [3 April]

  1. Chaos skin lesion showing some serpentine/ branched vessels and different shades, however no specific pattern can be seen. and the man has a history of melanoma. Anyway in such a case we excise to rule out any malignancy.

  2. I see two seperate lesions :
    1- The main pigmented lesion which is sharply demarkated with brown circles looks like Seb K to me.
    2- the upper out of focus lesion seems to have some clues including Rossette at 12 o clock and serpentine vessels.

    I would follow up the lesion in 3 month time.

    Thanks for sharing the case.

  3. Clinically looks like Seb K

    Dermoscopically looks like a solar lentigo- benign pattern, no cancerous features and well demarcated sharp borders with no chaos

  4. The lesion shows asymmetry with areas of depigmentation that show vascularity. There are a few milia cysts but the sharp edge in parts is worrying. In view of the past history, and the serpentine vessels a malignant melanoma has to be considered and advise excision biopsy with a 2mm margin.

  5. It is interesting that we have quite different views here – quite understandably. This is tricky. I think we all agree that there are several clear features of Seb K. The question is – can you be sure that it is ALL Seb K? If you are not sure, absolutely sure, I would advocate action on the day; not review and follow up. My view here is that if you have doubt / some suspicion, then you should act on the day. Follow up can only lead to pain! Patients don’t come back, lesions can grow etc etc.

    Why not do a quick shave excision biopsy on the day and be reassured / done with it?