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1800 867 1390Case discussion: How would you treat this patient? [20 November]
This week, we have another wonderful case from Dr Slavko Doslo. A 65-year-old female 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
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1800 867 1390
chaos,white eccentric structureless area,some thick lines reticular. Excision
Dermoscopy: 1cm brown lesion; asymmetrical, atypical, nil blue-white (2/3), for excision biopsy suggested.
Clinically/Macroscopically: a brown papule, ~ 8mm x 6mm.
Dermoscopically:
Chaos in term of structure and color.
Clues: thick reticular (lower part), pale-white centric structureless, dotted v/s (if look into carefully by zooming) especially in the structureless area. Despite lack of strong clues, Fairly enough for 2-3mm margin excisional biopsy and go from there.
Imp: LM or LMM /(MiS).
no melanoma specific features other than central scar like depigmentation, appears more of a minimally dysplastic nevus or a sclerosing nevus. given that it is a loner lesion on an elderly patient, it warrants a shave biopsy
Next step- 5mm margin excision if not done yet.
Wide excision with 5mm margin.
The key for this case, in my view, is to take the clinical appearance seriously. It is so small and innocuous! many doctors would ignore this. The dermoscopy makes it easy – I agree 2/3 on 3-point leads to excision biopsy and then 5mm margin excision. Great pick up here – key is to be suspicious of lonely lesions