Case discussion: How would you treat this patient? [19 February]

This week we have an interesting case from Dr Slavko Doslo. An 55-year-old female with past history of melanoma. The below shown lesion was noted on examination. 

Please review and describe the clinical and dermoscopic image. What is your evaluation, and differential diagnosis?

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?

Case discussion

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12 comments on “Case discussion: How would you treat this patient? [19 February]

  1. scores at least 2 out of 3 using the 3 point test. asymmetry/pigmented network. Not sure of blue white structures in view of image quality. Safe to do an excision biopsy. Moreso, in view of previous history of melanoma

  2. This is a suspicious lesion scoring 2/3 and against background history of melanoma, I would advise an exclusion biopsy with a 2 mm margin

  3. It doesn`t look real chaotic to me – it could be just a benign Clark naevus with some polymorphic colour aspect in the central part of the lesion. Comparing with other nearby lesions might help to get some reassurance if they look similar .
    But (on zooming in) I think I can also see some loop vessels in the central hypo-pigmented part, and possibly some dot vessels, which is a worry – possibly irritation from a trauma – as there also appears to be some superficial erosions?
    All in all there is some concern, particularly in a patient with a history of melanoma – biopsy now, or at the least a short term follow up after 3 months is indicated.

  4. This lady has proved she grows melanomas and ,if one cannot say with absolute certainty that this not another one,it has to be excised in full.
    With that network atypia,it has to go.

  5. Certainly warrant excisional biopsy for this ugly duckling among adjacent few pigmented spots + PHx of Melanoma. Imp: LM/LMM (Mis) or Dysplastic naevus.

  6. I believe the excision has had enough marginal clearance for a mildly dysplastic naevus & no further action is required.

  7. It’s probably safe to reassure the patient and follow up every 3 months in view of histopathological findings.

  8. My own view on this is as follows: 1) taken in isolation the image is (to my eye) completely benign, but 2) in the clinical context, there is enough doubt to excise. It really comes down to what you see on the day, so often.

  9. symmetrical in shape and colour compound naevus with mild dysplasia in a patient with past history of MM.
    Complete excision and close follow up are required