Case discussion: How would you treat this patient? [4 September]

This week we have another engaging case discussion from Dr Slavko Doslo. A 76-year-old patient presented for ROS.

What do you think of this clinical image? What is your impression? (Ignore the adjacent scar).

slavko_161205

Here are 3 dermoscopic images. Report was “in suit melanoma”: how would you treat?
Case discussion      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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10 comments on “Case discussion: How would you treat this patient? [4 September]

  1. The lesion looks suspicious- asymmetrical, atypical network, variable colors, dots, blotches. I would perform deep shave biopsy and rule out Melanoma.

  2. Chaos= asymmetrical in term of color and structure.
    Clues= one blue clod inferiorly with varied color through out. Irregular net work. Would be nice for detailed dermocsopic pic. Overall my gut leads to suspicious pigmented lesion (melanoma) and favored for 2-3mm margin excision, and go from there.
    Regards

  3. Pigmented chaotic skin lesion which looks suspicious. it has also different shades and structures (darker blotch inferiorly and thick line reticular / streaming peripherally), and some red area (vessels). Would be nice posting the dermatoscope as naked eye appearance wont help that much.

  4. PSL, chest wall next to thoracotomy scar. Chaotic pattern. Clues of grey dots and a bloch. Peripheral segmental radial lines. Vessels clusters. Clues to seb k present.
    Dx LPLK. DD 1. Melanoma, 2. Pigmented Bowen disease.

    I cannot exclude malignancy. Options of deep shave biopsy or multiple punch biopsies.

  5. I would’ve thought of this lesion to be an Invasive melanoma given the white lines which were arranged radial segmental fashion with a collision between a solar lentigo on lower half with melanomatous features of regression on upper half- black dots and globules, dermoscopic grey, polymorphous vessels and chaos with irregular borders. if this was a scar in relation to a melanoma excised prior, it would’ve led me along the lines of ? melanoma mets. good case