Case discussion: How would you treat this patient? [18 September]
This week we have an excellent case from Dr Ross Baverstock. A 48 year old male presented for a routine skin check with skin type 3. Dr Baverstock noticed lots of benign looking naevi but one of them stood out in the right scapular area.
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?
Dr Baverstock found it suspicious, so did an excision biopsy. Histopathology reported as:
Clinical Details: Excision biopsy suspicious pigmented lesion right scapular area. Suture medial. Macroscopic Description: Right scapula: An orientated skin ellipse 9 x 4 x 6mm with a central well circumscribed brown macule 2mm in diameter. A suture marks the medial aspect arbitrarily designated 12 o’clock, the 3 o’clock margin is inked green, the 9 o’clock margin is inked black. 3-2P JXT
Microscopic Description: Sections show a predominantly lentiginous junctional melanocytic proliferation. A few small nests are seen and the papillary dermis demonstrates lamellar fibroplasia. A dermal melanocytic population is not present though there is melanin deposition within the papillary dermis. There is also fibrosis and chronic inflammation with the changes in areas being in keeping with regression of the lesion. There is architectural and cytological atypia within the lesion, the margins of which are poorly defined, though the changes fall short of a diagnosis of malignant melanoma in-situ.
Conclusion: Skin lesion right scapula: Severely dysplastic junctional melanocytic naevus. There are changes in keeping with regression. The lesion extends within 1.5mm of the 3 o’clock margin and further local excision is recommended.
What would you do next?
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