Case discussion: How would you treat this patient? [21 May]

This week we have an interesting case from Dr Thuy Au. An 72-year-old male was being examined for a chest infection and this lesion was noted.

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

Case discussion     Case discussion

Update:

These are the results from the pathology report. What is your conclusion and what are the next steps you would take to treat this patient?

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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12 comments on “Case discussion: How would you treat this patient? [21 May]

  1. Blue white structures/atypical networks/asymmetry in colours. Merits excision by 2mm margin.

  2. asymmetrical, thick reticular lines, eccentirc hyperpigmented areas , rule out MM- excise with 3mm margins

  3. Chaos with different shades, thick line reticular, and an eccentric darker area/ Blotch. All mandate an excision for histology examination to rule out MM.

  4. thick lines reticular along lower border with central regression grey needs shave done to rule out SSM

  5. There is chaos and clues
    Thick reticular line
    Regression
    Grey coulor
    White line and circles
    Diagnosis , malignant melamona
    Treatment , excisional biopsy with 2-5mm at least from border

  6. Clinically a PSL macule over back with Chaos in term of structure and colour.
    Clues of thick reticular, polygons (complete & incomplete), dark-grey clod, and brown structureless warrant a 2mm excisional biopsy to r/o MM (likely LM/LMM). Then +/- WLE.

  7. not everything is a skin cancer! the clinical is not very impressive I think. I would score 2/3 on 3-point and agree biopsy is needed. I would do a shave – quick and easy

  8. on my 2nd thought of having dealt with junctional nevi so far , i should have left this lesion alone

  9. Thank you everyone for comments. I initially planed to shave, but then changed my mind last minutes because the more I looked at it the more it looked so suspicious.

  10. The reticular pattern is largely similar to that of the surrounding skin.
    Only at 2 O’Clock does it look different. However,the centre of that part is almost a perfect circle. For this reason I don’t believe this a malignant melanoma. This is one pigmented lesion I would just observe.

  11. I would biopsy (deep shave) this lesion as it looks like a potential melanoma – unless if the patient has several other similar looking dysplastic naevi, then one could consider observing it – again on condition that one has an imaging system that allows you to keep and compare dermoscopic pictures, and if you believe the patient will actually be compliant with the folllow up.