Case 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?

Case discussion_Slavko Doslo     Case discussion_Slavko

Update:

This is the pathology result. What is your conclusion and what are the next steps you would take to treat this patient?

Case discussion_Slavko     Case discussion_Slavko

We encourage you to participate in the case discussions and submit your own clinical images and questions so we can all learn together.

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9 comments on “Case discussion: How would you treat this patient? [30 October]

  1. 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 .

  2. 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

  3. 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.

  4. I need clarify whether the second excision is needed as margins clear with 2.5 mm for a superficial melanoma

    1. 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)

  5. 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.

    1. 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?