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1800 867 1390Case discussion: How would you treat this patient? [22 January]
This week we have an interesting case from Dr Slavko Doslo. A 40-year-old female with concerns about a lonely lesion noted on her foot.
Please review and describe the clinical and dermoscopic images. What is your evaluation, and differential diagnosis? What would you do?
Update:
Here is the same lesion 10 months later and the results. What is your conclusion and what are the next steps you would take to treat this patient?
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1300 856 695
+44 203 514 0688
1800 867 1390
Marginal area, non parallel ridge, non typical pattern , less than 7 mm, follow up in 3/12 although it looks like Crista reticulated pattern nevus but the dots are located asymmetrically and melanoma can’t be ruled out.
I guess you could call it a chaotic lesion with dots more concentrated in one part of the lesion and rest appears structure less. Quite a few dots appear in the periphery of the lesion, and there is a small greyish area in the centre of the lesion. Not a clear ridge pattern but definitely no furrows either. Not sure – so I would opt to biopsy this based on the findings in the initial pic.
I cannot detect any clear change after 10months observation – other then that the overall lesion appears a bit more pigmented – likely seasonal change!? Biopsy report says mild dysplastic naevus – I would be happy to not do anything more at this stage.
It’s been excised with narrow margin & results is a mild dysplastic nevus so no need for further excision. For moderate or severe dysplastic nevus further excision with 5 mm margin is indicated.
With the result revealing a mild dysplastic naevi completely excised, It I safe to do nothing further
There has been a significant change in the structure of this lesion in a period of 10 months. Clinically it is not behaving like a benign naevis. I would be speaking to the pathologist and requesting further review
tricky case, right? age is “borderline” for higher risk, and patient expresses “concern” about the lesion. For me – that is enough, and it is lonely, to remove. On clinical and dermoscopy, I don’t see anything to worry me, but the history / risk overrides that, for me. I would excise fully with a large punch. report of mild dysplasia really is meaningless – it is benign and no further action is needed. I would urge GPs not to monitor these lesion – you are only waiting for things to get worse. make a decision on the day