Case discussion: How would you treat this patient? [11 September]

This week we have a great case from Dr Umesh Sharma. A 52-year-old female presented for a first-time skin check after her husband was diagnosed with level 1 melanoma and a couple of BCCs recently. On examination, a lonely pigmented modular lesion was located hiding in the right lower lateral skin fold on the back.

We have the dermoscopy picture below. What do you think about the lesion? What are the next steps you would take to treat this patient?

Case discussion Umesh Sharma

Case submitted by Dr Umesh Sharma


This lesion scores 3 on the 3 point checklist and is asymmetrical and disorganised enough to mandate excision biopsy with 2mm margins. Melanoma until proven otherwise in my view.

– Prof. David Wilkinson

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? [11 September]

  1. chaos with asymmetrical colour and bluewhite, black clot peripheral, aborising blood vessels. needs excisional biopsy 2mm margin and go from there

  2. choas with different shades, white lines, segmental pseudopods, polymorphic vessels, and angulated lines, excise to rule out MM

  3. CHAOS in structure (asymmetric) and colour ( > one).
    1/ Peripheral dots and clods + subtle pseudopods (R hand side, 4-5′ o clock)
    2/ White/grey lines central
    3/ Pale-pinkish Strucureless (L hand side) and Brow-black Strucureless (R hand side)
    4/ Thick reticular with follicular obliteration, forming subtle Polygons (from L hand to inferior border).
    5/ subtle v/s dots (Polymorphous) R hand side between 2 pigmented parts.
    Enough to strongly suspect for MM (Imp: nMM) and thus 2-3mm margin excisional biopsy and go from there.
    nMM= nodular Melanoma.

  4. Invasive level 4 melanoma, rather unfortunate. Has White lines radial, polygons, regression with dermoscopic grey and black dots, multiple colours, radial streaming with pseudopods and chaos