Case discussion: How would you treat this patient? [11 December]

This week, we have another interesting case from Dr Slavko Doslo. A 46-year-old female presented for a skin check and a lonely lesion was found as indicated.

What is your assessment of the clinical and dermoscopic images? What would you do – if anything?

Slavko-Doslo_Case discussion      Slavko Doslo Case discussion

Case submitted by Dr Slavko Doslo

Here is a picture submitted by Dr Tim Aung to complement his comment below.

Update 2

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

case discussion     case discussion

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

  1. Thick lines reticular 5 o’clock….gray dots 6 o’clock….
    ?? melanoma
    For excision biopsy with 5 mm margin

  2. There is dermoscopic grey plus black circles around hair follicles- annular granular pattern surroundings which warrant excision. it does not have a Seb K feature or a benign melanocytic nevi picture from what i was thinking it would look like unfortunately

  3. A solitary lesion noted on face. Darker brown streaks on the periphery esp on 5 & 10 o clock. Nil clear irregular peri-follicular hyperpigmentation, grey nor rhomboidal structure that I could detect. Suggest an excision biopsy 2mm margin for histology diagnosis.

  4. This slightly raised dark papule 5x6mm in mid-40s female had interesting dermoscopic features:
    CHAOS in term of structure (asymmetric) and colours (dark, white/pale),..
    CLUES:
    1) impressive RADIAL STREAMING and PSEUDOPODS almost around the lesion,
    2) multiple PERIPHERAL and CENTRAL DARK DOTS/CLODS,
    3) multiple WHITE ECCENTRIC STRUCTUTRLESS/large WHITE CIRCLES + ?SUBTLE POLYGONS

    Certainly warrant 2-3mm margin excisional biopsy and go from there. I am inclined to Spreading type (SSM with +/- vertical growth) or nMM. Many thanks for sharing case.

  5. A dogs breakfast type dermoscopy pattern , lesion appears raised => excisional biopsy w 2mm margins. Next might need wide excision w 10mm margins – depending on histology and Breslow of – and referral to melanoma unit/ check cervical and supraclav lymphnodes!

  6. Hello everyone, easy case this week, in some ways. Very lonely pigmented lesion, no possible reasonable benign diagnosis. Hence excision biopsy with 2mm margin (not 5mm) needed. Personally I don’t see any melanoma-specific criteria (but I am not very good at that) on dermoscopy. So, biopsy anyway – MIS confirmed, and further excision with 5mm margins leads to cure! Great stuff.