Case discussion: How would you treat this patient? [14 August]

Here we have a case of 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 Doslo     Case discussion_Slavko Doslo

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_Slavko Doslo

Case submitted by Dr Slavko Doslo

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

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4 comments on “Case discussion: How would you treat this patient? [14 August]

  1. Lesion with asymmetry in shape . There is colour variegation with dark area inferiorly.
    There are cysts. The differential diagnosis is between a Seb K and a more malignant lesion inferiorly. There may well be 2 pathologies in this lesion. It definitely warrants an excisional biopsy with 2 mm margins .

  2. Loner lesion,assymetrical and more than 5mm, elderly man with skin type 1, looks like a melanoma arising within a regressed solar lentigo. Has dermoscopic grey with polygons and peppering with black dots, warrants excision but I wouldn’t be surprised if it came back solar lentigo

  3. an ugly duckling lesion.
    Chaos present: very asymmetrical in structure and colour (dark, brown pinkish).
    Clues: 1/ thick reticular lines with follicle obliteration (dense dark pigmentation), very irregular and broken network; 2/ structureless pinkish area (centric as well as eccentric).

    Needing to r/o MM and thus suggest 2mm margin excisional biopsy and go from there.

  4. Chaos showing thick line curved at upper part and some polygons if we can call so, at lower part with grey and peppering? and grey brown clods/ dots and some red branching vessels. Cut to exclude MM.