Case 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?

Case discussion Slavko Doslo     Case discussion Slavko Doslo

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?

Case discussion   Case discussion

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6 comments on “Case discussion: How would you treat this patient? [22 January]

  1. 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.

  2. 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.

  3. 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.

  4. With the result revealing a mild dysplastic naevi completely excised, It I safe to do nothing further

  5. 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

  6. 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