Case discussion: How would you treat this patient? [06 November]

This week, we have another interesting case from Dr Slavko Doslo. A 59-year-old male presented for a Skin check and a lesion was noticed. Unfortunately, we do not have the clinical images. 

The challenge this week is to describe the dermoscopic picture as we all know what the diagnosis will be.

Case discussion_Slavko doslo

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

Case discussion_Slavko

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5 comments on “Case discussion: How would you treat this patient? [06 November]

  1. Chaos in colour and structure. Eccentric grey and black dots. Negative network. Polarising white lines. Probably melanoma. Excision with 2mm margin.

  2. Large (about 11 x 17 mm) PSL with pink background, chaotic in pattern and colour, peripheral network of brown circles with negative network (more clear on the upper right). Clues include large eccentric structureless area, black clods and grayish brown circles in addition to polygonal white lines and a lot of dot and glomerular (coiled) vessels with some small linear vessels (?Polymorphous vessel pattern).
    The picture is of a SSM with DD of Pigmented Bowen disease.

  3. To describe the dermoscopic picture as we all know what the diagnosis-
    I. Chaos present: asymmetric in structure and >1 colours (pink, brown, white,..)
    II. Clues:
    1/ Eccentric and centric pinkish structureless with whites lines
    2/ if zoom> scattered dotted or polymorphic v/s (especially R hand side)
    3/ 7-8’o clock- round/oval with central red dot (v/s) which is very interesting.
    4/ subtle octagons/polygons especially peripheral.

    D/Dx in order: Hypomelanotic MM/MM, pBCC, IEC (Bowen d/s).
    2-3mm margin excision and go from there .