Case discussion: How would you treat this patient? [12 June]

This week we have another engaging case discussion from Dr Tim Aung. Elderly male presenting for a script following relocation. Skin check offered and this lesion noted. Apparently present for “years”.

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

Case discussion - Tim Aung

Case discussion - Tim Aung     Case discussion - Tim Aung

Update:

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

Case discussion      Case discussion

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? [12 June]

  1. The lesion is asymmetrical in pigment and shape. I would think of superficial spreading melanoma

  2. Dermoscopy is showing multiple colours including gray colour, probably rhomboid structures, and eccentric pinkish structureless area at 6 o’clock. It should be biopsied preferably excisional biopsy

  3. The lesion is asymmetrical, has mixed colours-pink, brown and dark brown, thickened lines reticular over half the lesion. I would say superficial melanoma? Definitely biopsy. I done do shave excisions because i worry about not getting the correct depth.

  4. This is a clear cut case of what is a benign Seb K/lentigo on the face. Reassure the patient and recheck lesion in 6 months

  5. two shades only and no specific criteria can be found on a sun damaged kin. So maybe short time checking.

  6. Let me give some hints here: 1) elderly male, white, Australian (presumably), 2) what looks like a solitary lesion although we don’t see all the face, 3) facial skin requires we assess lesions a little differently from other parts of the body and 4) there are no features of lentigo here (moth-eaten borders etc). Can you really be sure this is benign?

  7. Clues are variable thick circles of pigment. Can’t see grey circles. This demographic grows skin cancers. This is not a Seb k or lentigo. Excision biopsy mandatory.

  8. Its really a difficult case and those polygons like structure, not sure if they are called as such with this outlook. Anyhow since its proven LM, then an excision with wider margin as its involved to remove it all.

  9. Just little feedback. We all agreed for Chaos in term of colour and structure. In term of Clues to my eyes were:
    1/ thick reticular
    2/ Obliteration of follicles (d/t melanocytes proliferation) > clods
    3/ Polygons which is always the case of controversial as some do not establish as one of important clues (eg. Dermnetnz.org > only 8 clues). ?It was not apparently widely accepted.

    The lesion has been re-excised with 5mm margin as par guidelines.
    ta 🙂