Case discussion: How would you treat this patient? [9 July]

This week we have an engaging case from Dr Peter Ryan. An 70-year-old male presented for treatment of solar keratosis on his hand. Full body skin check was done during his visit.

What is your evaluation 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?

Case discussion

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6 comments on “Case discussion: How would you treat this patient? [9 July]

  1. dermoscopic grey, thick reticular network, regression central and chaos, consistent with superficial spreading melanoma on the back. needs 5mm wide excision margins since the diagnosis is staring at your face

  2. A chaotic ugly duckling.
    Irregular border, shape, colour and network.
    Blue / white structure.
    Eccentric structureless area inferiorly.

    Excision with 5mm borders.

  3. Suspicious for invasive melanoma: large whitish areas of regression, as well as grey-blue structureless areas, and some remnant atypical network on the edges. I would recommend ellipse excision with 2mm margins.

  4. Looks nasty; ugly duckling; asymmetry colour and structure; blue white veil, peripheral black clods, grey colour, segmental radial lines superiorly, eccentric structureless area; should be excised with 2mm margin for diagnosis and synoptic report, with WLE to be done at same time as sentinel node biopsy if sentinal node biopsy indicated

  5. Not much to say here really – we all agree that this is a melanoma clinically and dermoscopically. It is likely invasive due to the features on the dermoscopy. My own way to handle this would still be to do 2mm margins and then go from there

  6. Hi David,
    Given the margins were involved, how would you assess where to measure your wide local excision margin from?
    Cheers, Bronwyn.