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1800 867 1390Case discussion: How would you treat this patient? [30 October]
This week, we have another wonderful case from Dr Slavko Doslo. A 77-year-old male presented for a skin check and a lesion was noticed as indicated.
What is your assessment of the clinical and dermoscopic images? What would you do – if anything?
Update:
This is the pathology result. What is your conclusion and what are the next steps you would take to treat this patient?
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1300 856 695
+44 203 514 0688
1800 867 1390
Chaos with different shades, angulated lines, brown dots, dark blotch. Excise to rule out MM.
I could see on enlargement some thick line reticular and a red rounded area beside it at top.
An irregular pigmented lesion . Dark areas in centre and periphery. It has a reddish area above the 1 o’ clock periphery. A Probable malignant melanoma. It warrants an excision biopsy including the reddish area .
looks like a sclerosed nevi, needs a comparative approach and if different from other nevi, will need excision to rule out SSM. There are no obvious melanoma specific changes other than dermoscopic black with some chaos
Clinically- a flat pigmented (lentigenous) lesion with a small erythema nearby (1′ o clock).
Dermoscopically- Chaos present with asymmetric and >2 color.
Clues: 2 or 3 central dark clods with subtle structurelss and thick reticular lines especially R hand side (3′ o clock).
Suggest 2-3mm margin excisional biopsy including nearby erythema (difficult to identify v/s pattern-?AK) and go from there.
I need clarify whether the second excision is needed as margins clear with 2.5 mm for a superficial melanoma
second excision is 8 mm wide so 4+2,5 mm = 6,5 mm more than needed. I always excise more as I want ” fresh ” edges not disturbed with previous stitches , ( if I have enough tissue in area)
for me, the clinical view makes me want to look at the lesion with my dermoscope. I don’t see anything there that makes me define as “benign”. So, for me excision biopsy needed with 2mm margins. SSM is confirmed, and so then re-excise with 5mm margins. Remember the margins are clinical and nothing to do with what is reported by the pathology report.
Thank you prof. Wilkinson
Can I also ask you that recently I excised the superficial melanoma with 5 mm margins and the histological report came as nearest margin 4.5 mm clear of the lesion
Does this need another wider excision?