Case discussion: How would you treat this patient? [30 July]

This week’s case discussion is about an elderly man presenting for reasons unrelated to his skin. A full skin check is done and these clinical and dermoscopic images are taken. How do you evaluate them?

case discussion-slavko     case discussion_slavko

Update:

This is the pathology result. What is your conclusion and what are the next steps you would take to treat this patient?

Case discussion

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? [30 July]

  1. Chaos of colour and structure, showing polygons/ angulated lines incomplete, follicular obliteration on the right side, dark blotches, short line curved at the lower part, and a pink area with fine branching vessels….all warrant a malignancy.

  2. this is an invasive melanoma arising within a solar lentigo, loner lesion in an elderly, an ugly duckling lesion

  3. Agree there is chaos, there are polygons, thick pigmented lines , some grey areas, polymorphic vessels, pigmented dots and clods.
    A Melanoma developing within a solar lentigo sound correct Ash.
    I would think a 5mm margin excision of the lesion.

  4. A standout, ugly-ducking lesion with
    – CHAOS in term of colour and structure
    – CLUES: (especially R side 4-5’ o clock)
    Thick reticular lines
    a few Polygons
    Black/dark dots and clods (centrally + peripherally)
    Follicular obliteration (although not one of 9 clues). Sorry unable to see obvious v/s pattern pointing any specific Dx.
    Sufficient enough warranting biopsy to r/o MM.
    There is a disjoint network with one dark clod at 5’ o clock, and I felt all be included either in shaved or 2-3mm margin excisional biopsy, and go from there.

  5. Chaos of colour and structure with thick lines reticular obliterating some follicular openings , blue grey structures and some peripheral black globules /dots ,polygons – looks like lentiginous melanoma

  6. asymmetrical, chaotic, atypical network, thick retic lines periphery, blotches, perform excision with 3mm clinical margins to rule out Melanoma

  7. 5 mm further clinical margins as per guidelines to prevent local recurrence even though we have close to that with the excision biopsy