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

This week we have an engaging case from Dr Dorothy Dowd. A mid thirties gentleman obviously has multiple mole syndrome from the image below. So, two issues:

  1. What is your assessment of the 2 lesions Dr Dowd shows here?
  2. How do you manage these patients in your practice?

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Case submitted by Dr Dorothy Dowd

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

  1. The first one on the left has an atypical dermoscopic island with a preexistent nevus, it needs a shave done

    The 2nd lesion on the right appears more in favour of a mildly Dysplastic nevus given some central grey regression within a globular nevus, 2nd lesion can be left alone and rechecked in 4 months for changes of growth

    On the whole people with multiple nevi should be managed in a specialised center using molemap which detects subtle changes and interval growth patterns which offers a comparison of morphology and features enabling early detection of changing melanocytic lesions

  2. Both looks to me nevus, however first one is with same shade with no specific pattern, and the second shows white scar like area and some chaos with different shades with brown clod? watch them

  3. 1. lesion 1 on the left has atypical network, I would do a shave
    2. leison 2 on the right has chaos- structureless area, grey, ?black clod- i would do excisional bx with 2mm margin.
    3. I would also refer the pt for molemap FU.

  4. Would be nice with arrow/circle marking over the back to reflect which dermoscopic pictures. Anyway:
    I. 1st lesion on the left: more inclined to Naevus although a few polygons with nil other strong Clues.
    II. 2nd lesion on the right: C & C present. But also looking like SK but it is more common in >40-50 aged. D/Dx for this in order- Naevus (Dysplastic), pSK and MM. Favored for 2mm margin excision and go from there.
    Plan: 6/12ly skin check with clinical and dermoscopic photos documentation/filed of each visit to be able to analyse and compare.

  5. These are very challenging patients to manage, in primary care in my view. This is the approach that I take, based on my synthesis of expert advice and guidelines. I am heavily influenced by Prof Harald Kittler in this regard. And, I imagine how I would answer this question “if this was me, what care would I insist for myself”? First, I would recognise that a GP alone (however well trained and however experienced) cannot provide complete care. These patients need both digital imaging of nevi, and whole body photography. Remember that most new melanomas in these patients arise in normal skin, so imaging nevi only is not enough! So, I would arrange care through a GP with special interest and expertise in skin cancer, AND I would insist on MoleMapping (I have no affiliation with them). Finally, I would need to look at all the nevi to decide whether either of the 2 shown today are “outliers” from the rest.

  6. I think total body mapping is appropriate rather than “Mole Mapping” which I have found to be relatively substandard