Case discussion: How would you treat this patient? [16 July]

This week we have an interesting case. From the shown clinical and dermoscopy images, please evaluate, indicate your likely diagnosis, and method of biopsy.

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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8 comments on “Case discussion: How would you treat this patient? [16 July]

  1. Structureless areas, grey/white veil, no network seen, possibly some scattered brown clods, some overlying crust. Presumably an ‘ugly duckling’ lesion in the context of the rest of the skin. Excise with 2mm margins as clinically a suspicious lesion for melanoma.

  2. Brown and pink make me frown. No specific pattern. There is however surface segmental scales and two white circles and few scattered black/ brown dots/ clods. Should be off. DD could be SCC well differentiated / ? MM.

  3. non contact dermoscopy offers very poor quality images and this is an example, it always requires contact polarised with oil immersion to form a diagnosis with a good image. very non specific dermscopic grey pattern, no diagnosis possible !!

  4. This pigmented lesion is ill defined with grey areas and eccentric structureless areas. It can’t be named as benign, and should be removed with a 2mm margin.
    Having now seen the pathology, I would regard this lesion as treated, with no further excision required.

  5. Interesting diagnosis! Just goes to show that we can’t always get it right on dermoscopy, but the biopsy usually does the trick!

  6. Hi David,
    Would you re-excise this lesion with a wider margin if the original margin was 2mm, or do you think that a 2mm margin is adequate for an IEC?
    Cheers, Bronwyn.