Case discussion: How would you treat this patient? [27 November]

This week, we have another fantastic case from Dr Slavko Doslo. A 72-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 Doslo

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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11 comments on “Case discussion: How would you treat this patient? [27 November]

  1. Dark brown melanocytic irregular, atypical lesion. Highly suspicious of a melanoma.
    Suggest excision biopsy of this entire lesion with 2 mm margin.

  2. Thickened pigment network
    Asymmetry
    Blue-white structures
    Requires excisional biopsy with 2mm margin- likely to be a melanoma arising from a dysplastic naevus

  3. There is a dermoscopic island with black dots more towards one side of the lesion, i would first do a tape stripping of this lesion to remove the black pigmentation on top and then redo dermoscopy again, only then will i decide to excise this lesion if the remaining pigmentation looks the same. otherwise if the black dots and networking dissapears, i would leave this alone

  4. Sorry for late joining.
    Impressive dermoscopic features centrally (thick retic, dots/clods, grey-white), but not peripherally > Warranted 2-3mm margin excisional biopsy.
    Noted HP- dysplatic junctional naevus. Wished to seek 2nd opinion of HP by sending pictures as well to ensure.

  5. It looks to me that there is some disparity between the dermoscopic image and histopathological findings. Dermoscopically, it is highly suggestive of Melanoma, considering the asymmetry, thick reticular lines, atypical network and various colors, while the histopathology says there is no sign of malignancy and that it is completely excised with the closest margin of 4 mm. I think I will closely follow this up and ask the patient to return in 3 months or earlier if any signs of recurrence.

  6. Don’t blame too much on pathologist. It is sensible to seek 2nd opinion of HP in this particular case. Let’s keep in mind, Dermoscopic clues peripherally are more significant than central. Despite strong C & C, its specificity is 60% and sensitivity 90% only.

  7. A tricky one, right? For me, this has to be removed, based on the dermoscopy. And is fact this has already been done by Dr Doslo. I would not feel the need to do a further excision here. The dermoscopy is striking but not impossible to see in benign nevi, on occasion

    1. I will start collecting all those ” dysplastic” into 3 categories, mild, moderate and severe to watch for further developments in testing and categorisation as science might develop new marker to show us that some of them are true Melanomas. In that way I will be able to recall all my ” suspicious” cases.
      I just removed one 99,9% seb ker and 0.1 % melanoma case ( patient agreed with me that should be ” gone” ) better small scar than headache