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

This week we have a great case discussion from Dr Dave Stewart. An elderly male presented with a bleeding lesion, found to be a BCC. On full skin check, the following lesion was identified.

How would you evaluate this dermoscopic view? And, what would you do next?

Update:

What is your interpretation and what would you do next, in light of this result?

Click to view the Pathology Report here 

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


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11 comments on “Case discussion: How would you treat this patient? [5 June]

  1. Chaotic pigmented lesion.
    Clues present – eccentric structureless area; grey-blue structures; black dots; polymorphous vessels.
    Excisional biopsy with 2-3 mm margins.

  2. Chaos in colour and structure.
    Clues:
    1/ pale-pinkish eccentric structureless with polymorph vessels (centrally)
    2/ blue-gray L side + cluster of grey dots (7-8′ + 1′ o clock)
    3/ peripheral brown dots/clods (10′ o clock)
    4/ thick reticular (2′ o clock)
    5/ irregular border throughout

    Suspicious enough for MM (?SSM) and warrant excisional biopsy. Go from there.

    1. CORRECTION re. typo.
      Chaos in colour and structure.
      Clues:
      1/ pale-pinkish & whitish structureless with polymorph vessels (centrally, not eccentric)
      2/ blue-gray L side + cluster of grey dots (7-8′ + 1′ o clock)
      3/ peripheral brown dots/clods + subtle radial streaming (10′ o clock)
      4/ thick reticular (2′ o clock)
      5/ irregular border throughout
      6/ also a few polygons among grey dots/clod (7-8′ o clock)
      Suspicious enough for MM (?SSM) and warrant excisional biopsy. Go from there.

  3. Dermoscopic grey, chaos, multiple colours, polygons. need excision for r/o superficial spreading melanoma

  4. Chaos with different shades and structure in a PSL, that shows a pink structureless area with multiple thin branched vessels, a brown to dark dots, peppering with some subtle polygons?. thick line reticular segmental, eccentric grey blue? area? all of which denotes malignancy and should be excised.

  5. asymetry/chaos in structure and colour
    eccentric structureless area
    atypical network patchily in periphery
    area of blue/gray 8 o’clock, areas of grey dot peppering lower area
    some radial thick lines reticular and few peripheral dark clods
    polymorphous vessels
    features of malignant melanoma ? spreading
    requires excision. margin not clearly distinct – requies at least 2 mm margin for diagnostic biopsy and bresnow level prior to efinitive excision and management

  6. yes, an easy decision that this lesion needs biopsy. I don’t see any criteria that make a specific diagnosis most likely but melanoma is clearly in the mix, so 2mm excision biopsy is warranted

  7. The lesion is very suspicious and all dermoscopic features mention above are obvious except I am not sure if there is pigment network. including at 2 o’clock. Anyway this lesion needs excional biopsy.

  8. The case from Dr Dave Stewart. The BCC on the back was reported to be not cleared in the deep and radial margins. So this will require re-excision around the scar with at least 2mm margin, but I think 5mm would be ideal. The report on the melanoma-in-situ on the left shoulder will require a re-excision with 5mm margin.