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1800 867 1390Case discussion: How would you treat this patient? [28 August]
This week we have an interesting case discussion from Dr Gehad Hassanein. A female patient in her mid-40s reported a long standing lesion with a recent change in colour.
What is your evaluation and what would you do (if anything)?
Update:
Case submitted by Dr Gehad Hassanein
Please share your thoughts in the comment section below. Professor David Wilkinson will provide his opinion and advice.
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1800 867 1390
There r no specific pattern and the image is blurred. However as state a new change. Excise for histology.
For me lesion has uneven borders, missing structure in mid zones, different colors, 9 o’clock dot pigment concentration ( I call it pepper dots) so 4 points to me, excision, Melanoma in city or displastic nevus, anyway 2 mm excision margin for beginning . Plus patient reports recent color change. mid zone 2 large islands ( are they elevated above skin level (we do not have macroscopic picture)
Thanks
1. Patient reports change in a long standing lesion: needs to be taken seriously.
2. There is chaos in the lesion.
3. 2 obvious clues that I can see:
Structureless areas at 11 o’clock and 4 o’clock positions
Brown clods at 10 o’clock position, randomly arranged.
The lesion needs to be excised with 2 mm margins for histological diagnosis.
Question: would a generous shave be acceptable in this case ?
I think a Melanoma in situ needs to be ruled out. Also ? dysplastic naevus.
The 2 central dark brown areas: ? represent dry scab/crusting ???
the outward picture shows that of a nevus, however it has no appearance of a nevus or a lentigo, has 2 areas of greyish regression in the center plus black dots distributed throughout the lesion, needs excision to exclude a melanoma arising in a regressed nevus
Firstly a changed mole in adult require excision.
This has centrally placed 2 Irregularly shaped darkened areas an unusual appearance.
Dermoscopy shows latter to have irregularly thickened network characteristic of melanoma. There are also some dark globules eccentrically placed towards periphery indicating growth.
A wider excision should be considered.
Pathology diagnosis-In situ melanoma with no ulceration and regression on the shoulder, I would excise the lesion with 5 mm margins and repair direct or flap based on skin redundancy.