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1800 867 1390Case discussion: How would you treat this patient? [18 June]
This week we have an interesting case from Dr Tim Aung. An 50-year-old male (Same patient – 28 May case discussion) presented for a full-body skin check. Two pigmented lesions were found on the face, as shown. How would you biopsy these?
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?
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both are pigmented seborrheic keratosis, no cancerous features. leave them alone and reassure patient
I thought they both looked pretty benign. I would leave it. If I had to biopsy both of them, I would use shave biopsy method.
4 to 6 mm punch biopsies should be sufficient
The upper one is chaotic with brown clods and different shades, and the lower one show some dark blotches with brown dots only and clear follicular opening. I would follow them up i presume as no sign of malignancy can be seen really.
In view of history of melanoma it is easier and safer to shave excise these
I would do a 6mm punch excision of the lower one (irregular pigmentation around the hair follicles); I would do a shave biopsy of the upper (irregular pigmentation, grey) given the underlying nerve in this area
I wouldn’t do anything further as they are both dysplastic naevi with only mild atypia
Thanks for everyone’s contribution. Given having a large LMM with CLevel IV & BT 1.7mm in L face recently, I had to take seriously in checking whole body skin with +/- further step. Nothing suspicious was found except 2 small pigmented lesions hiding in beard bush R face. Dermoscopically: a mini similar pattern like left one especially upper lesion, requiring biopsy to ensure. Shaved biopsy was not considered due to recent thick MM. Excisional biopsy revealed CMN with CYTOLOGICAL ATYPIA. Clearance from lesion histologically 2mm x 3mm. Clinically a bit more than histologically.
Noteworthy is not to forget the HAIRY BUSH AREA. .
It is not wrong with large punch biopsy or shaved biopsy (if you felt less likely MM).
Tim, many thanks for sharing this case. Plenty to appreciate here. Checking the bushy beard is really important. I Don’t think dermoscopy helps with these lesions – by that I mean, it does not reassure me. My choice of biopsy would be shave or punch (big enough to remove the whole lesion). The past history is important I think, and would encourage me to biopsy, but would not change my biopsy choice. Thanks again Tim, for sharing