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

This week we have an engaging case from Dr Faizah Jabeen. An 11-year-old Asian background girl with a dark mole on left palm for around 1 year. Noticed the mole changing with increase in size and itchy.

What is your evaluation of the clinical image? What would you do next?

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? [23 July]

  1. Dermoscopy is not available but i can see parallel furrow pattern with lattices in the middle if my imagination is correct. Reassure the parents that no excision is required and send her home. This is a benign palmar nevus

  2. 11 year old – But
    Pigmented lesion on acral site
    Recent change
    Periphery ; Pigmentation in furrows
    Centrally ; Pigmentation on ridges
    Acro-syringia evident
    I assume glands have been checked for.
    Also, this is an area prone to trauma.
    Advice ; Remove for histology >

  3. asian non causian acral naevi tend not to be pure furrow pattern.
    Melanoma almost always a ridge only pattern with preference for melanoma cells to occur at crista profunda intermedia.
    The clinical dermatoscopic report missing ie not mentioned if furrow or lattice or fibrillar pattern. Macro photo suggests pigment lies in the narrow furrows seen at the periphery of the lesion.
    The path report not particularly helpful in it not using appropriate anatomical terms where the nests are located.which crista layer?
    Growing acral lesion in a 11 year old child who is also growing typically represents natural biological behaviour. Sounds like just needs explanation & reassurance. No further surgical intervention likely to be indicated

  4. really interesting case – these lesion require expert dermoscopy skills (you have either studied them or you haven’t) – you can’t make it up as you go along. I lean heavily towards removal if there is anxiety or history of change. Small ones, like this can be easily removed (in full) with a large punch. And then you really must get an expert to read the histology slides. Just as acral lesions are rare for us, so they are rare for pathologists

    1. David, what is the significance of the mild random cytological atypia?
      Does this patient need any further follow up even though the lesion is clear of margins?

  5. given the occurence of 1:1000000 for a melanoma in a 11 year old, excision is invasive and an unwarranted procedure that should be avoided in the first place, all that is required is reassurance

  6. Primary inspection leaves us with a difficult decision
    We know that 11 year olds, have lesions that change, and grow, but does that translate to histological changes also.?
    Does that make it hard to interpret?
    I find these path reports difficult to read . I thought we avoided terms like atypia and dysplasia now .
    I note it is being sent for another opinion.
    Would you ring and ask the pathologist if this wasnt offered.
    I am rarely that brave .
    Thanks