Case discussion: How would you treat this patient? [23 April]

This week we have another interesting case. This lesion was on the arm and the patient was unaware of it.

What is your assessment of the clinical and dermoscopic images, and what would you do next? 

Case discussion   Case discussion

Update:

Here is the pathology report. What would you do next and why?

Pathology:
– LENTIGO MALIGNA MELANOMA
– CLARK LEVEL II, BRESLOW THICKNESS 0.22MM

 There is malignant melanoma, best categorised as lentigo maligna melanoma in type. There is an irregular junctional proliferation of single cells and variably sized nests. Cytological atypia is mild-moderate. There is focal mild upward drift. There is focal dermal involvement, Clark level II, Breslow thickness 0.22mm. No dermal mitotic figures are identified. Tumour infiltrating lymphocytes are non-brisk. There is no significant regression fibrosis.

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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7 comments on “Case discussion: How would you treat this patient? [23 April]

  1. brown lesion with multiple patterns: structureless, reticular, clods You can also see some lines that are angulated. Chaos present Could be lentigo maligna

  2. Polygons, dermoscopic grey,scattered black dots. it is a melanoma arising within a preexistent Congenital melanocytic nevus. Needs narrow margin excision for histopath

  3. so I must be honest and say that the dermoscopy is bland for me. I hope the clinical view in real life would have led me to excise!

  4. There is chaos, also black thick lines and clods .
    Need shave bx which performed
    Now it’s LMM the details as reported ,
    We need to do excision with 10mm margin all around.

  5. Dear David
    Correct me if I am wrong.
    When you say clinical view (Hx + physical Ex/macro picture), there isn’t sufficient information to excise. To be honest, it would be better say holistic approach, both clinical + dermoscopic, or dermoscopic algorithm alone.
    if applied one of major algorithms (Dermoscopically):
    Chaos present in term of structure (irregular border, not quite asymmetric, and > one color (gray, dark, brown).
    Clues: obvious dark dots and clods centrally as well as peripherally in the background of brown and light brown pigmentation. I cannot see any obvious network. Whenever there is dense pigmented spots, it refer to excessive melanin proliferation and in some situation, follicular obliteration. Similarly TADA algorithm can be applied.