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1800 867 1390Case discussion: How would you treat this patient? [26 November]
This week we have an interesting case from Dr Peter Ryan. An 70-year old male had a skin check elsewhere, and advised laser treatment to pigmented skin lesion on forehead.
Please review images and provide your differential diagnosis, and advice on treatment options / next steps.
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?
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1300 856 695
+44 203 514 0688
1800 867 1390
The lower brown pigmented area has sharp borders and is suggestive of a flat Seb K – but not so clearcut – and when enlarging the pic I believe I spot lots of dark grey circles within the dark brown background – so a shave biopsy may be preferable (to a destructive therapy as laser). I wonder if the pale halo around the lesion is due to previous cryo treatment?
The upper part seems an example of pink and brown to make you frown. Laser without diagnosis? – no go!
There isn’t any specific network in the skin lesion and the border is clear cut sharp. SK.
There are grey circles – may be a melanoma-in-situ abutting SK
I think a shave biopsy of most or all of the lesion, to look for lentigo maligna. The circles and grey circle are clues.
I would give it a 2 on the three point check list. It could be a Seb K but not typical appearance so could also be a melanoma. Given area shave biopsy to take he whole lesion would be reasonable I think.
Seborrheic keratosis, leave the lesion alone
Speaking some one getting past being novice
It looks like a mixed seb K / solar lentigo
seb K clues thick curved lines ( but no white or orange clods)
solar lentigo thin curved lines (finger print like)
but has some grey circles in it.
Either shave or observe and review with image in 3 months. I assume will be
The key message here of course is that a PSL in an older male, that is at all suspicious is a melanoma until proven otherwise. No treatment without a diagnosis (which usually means a biopsy)! And, here it was – MIS. Don’t cut corners 🙂