Case discussion: How would you treat this patient? [30 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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5 comments on “Case discussion: How would you treat this patient? [30 July]

  1. Ddx
    1. melanoma metastases
    2. nodular melanoma
    need excision biopsy first before deciding further course of action

  2. Chaos, black clods
    Depending on the size, may be too large for an excisional biopsy being on the scalp.
    Suggestive,of a melanoma
    Would consider a shave biopsy.

  3. no diagnosis possible with non contact dermoscopy. dermoscopic grey needs shave biopsy done irrespective of lesion appearance on scalp or face as it forms an exception

  4. Looks awful clinically, suspect NM clinically; ideally excise 2mm margin, but may need to shave if unable to excise. Clark level 4, PNI – refer for to melanoma unit

  5. Not much to add here – obviously suspicious clinically and needs excision biopsy, with nodular melanoma in the mix. Pathology confirms this, so wide excision required