Case discussion: How would you treat this patient? [9 July]
This week we have another interesting case discussion from Dr Colin Armstrong. Please describe what you see here and what you would do next.
Here is the dermoscopy image – please describe the appearance and indicate your preferred diagnosis.
What biopsy options do we have?
Now, with these results, what would you do next?
Clinical Notes: Flap/WLE right scapula spine lateral – melanoma on bx
The specimen container is labelled ‘right scapula spine’. The specimen consists of a tear drop shaped portion of skin and subjacent tissues measuring 56 x 43 x 10mm. Examination of the skin surface reveals a cream and tan, irregular, centrally scabbed lesion measuring 30 x 30mm. A marking suture is present on an apex, indicating 12 o’clock. The 3o’clock margin is inked green and 9 o’clock margin is inked black. Blocking Details: 1A 1TS 1LS 12 o’clock; 1B 1TS bisected; 1C 1TS bisected; 1D 1TS bisected; 1E 1TS bisected; 1F 1TS bisected; 1G 1LS 6 o’clock.
The sections show a healing biopsy site which is completely excised. There is adjacent residual Level 1 malignant melanoma of lentigo maligna type. No residual Level 2 / invasive component is identified. The excision appears complete and residual Level 1 (in-situ) lentigo maligna melanoma has the following clearances: 3 o’clock – 5mm. 9 o’clock – 5mm. 12 o’clock – 7mm. 6 o’clock – 8mm.
WIDE LOCAL EXCISION, RIGHT SCAPULAR SPINE LATERAL: – RESIDUAL LENTIGO MALIGNA MELANOMA, COMPLETE EXCISION.
Please share your thoughts in the comment section below. Professor David Wilkinson will provide his opinion and advice.