Case discussion: How would you treat this patient? [15 October]

This week we have an interesting case from Dr Kiratikorn Punyatrong. A 24-year-old female presented for a full skin check. She has no relevant past history but has multiple naevi on her back and upper body. One naevus on her back is different from the others.

How would you describe this lesion, what is the differential diagnosis, and how would you biopsy this?

Case discussion

Case submitted by Dr Kiratikorn Punyatrong

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10 comments on “Case discussion: How would you treat this patient? [15 October]

  1. Pigmented flat skin lesion, chaotic w 2 out-of-centre structureless area`s – (light brown area at 6 o`clock + blue-white veil area at 9 o`clock) , irregular reticular network central part of lesion, irregular network. Highly suspicious for invasive melanoma of the superficial spreading type.
    Unless several other similar nevi in the vicinity would be present, this needs an excisional biopsy – preferably excision w 2 mm margin. On the back this could be done with a large ellipse either excise the lesion alone and do a staged excision
    PS. Looking back at the pic I wonder if the brown 1mm clod at 8 o`clock could be a satellite metastasis …
    Referral for a SLN biopsy seems a good idea.

  2. Pigmented macular melanocytic lesion, approximately 9mm diameter.
    Evidence of chaos in both structure and colour.
    Evidence of clues : blue / white area at 9 o/clock, structureless eccentric region around 5-6 o’clock and black dots centrally.
    Suspicious for melanoma.
    Suggest excisional biopsy with 2mm margins.

  3. chaotic lesion, structureless area at 9o’clock. at the centre there is irregular network. DDx: MM, for excisional biopsy 2mm margin

  4. Pigmented
    Eccentric Structureless are 9 o’clock
    Blue grey colour
    Brown dots 12 – 3 o’clock
    Atypical pigment network 3 o’clock

    Biopsy with 2 mm margins
    Follow up on histo.

  5. Looks like a midly dysplastic junctional nevus, im not convinced that this level of regression is of SSM. Do a comparative approach and see if the other nevi on the back match up. if so leave it alone, otherwise redo a skin check in 4 months time

  6. Pigmented flat looking macule 9mm. Irregular pigmentation asymmetry and network. Structureless area from 7-9oclock pigmented bluish. Lesion is different from other naevi. Would requires an excision with 2mm margins with advice for possible extension pending hpe. Dysplastic naevus/Ssm

  7. It is chaotic .
    The clue is blue grey area.
    There is a reticular area
    I would excise it

    Impression Dysplastic nevus

  8. reticular pattern peripherally with globules and structureless in centre.
    Central part is asymmetrical and I guess as the structureless part is grey it counts as a clue to should be excised.
    diferential diagnosis Clarks, Congenital or melanoma

    I suspect will be a congenital / globular type but would not be happy leaving it