Case discussion: How would you treat this patient? [3 December]

This week we have an engaging case. What do you make of the clinical and dermoscopic images here? No history, just clinical findings? Is this benign, is it suspicious? Why? What would you do?

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

We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.

MORE CASE DISCUSSIONS


Learn more about skin cancer medicine in primary care at the next Skin Cancer Certificate Courses:

Skin Cancer Certificate Courses in Australia

Leave a Reply

Your email address will not be published. Required fields are marked *

9 comments on “Case discussion: How would you treat this patient? [3 December]

  1. asymtrical PSL, with atypical network, balck dots/clod at 1-2o’clock- suspicious, 2mm margin excisional biopsy.

  2. Chaotic PSL. Peripheral dots. Radiating lines. This makes it suspicious. Excise whole lesion. 2 mm margins.

  3. The clinical picture looks benign enough. The dermatoscopic appearance is largely light brown in colour except an eccentric hyperpigmentation at one corner, 0-3 o’clock position. I this area though, there is no evidence of malignant behaviour of melanocytes. I would say no biopsy but review in 6 weeks to check if there is any change, then decide whether to excise or not.

  4. Suspicious flat pigmented (solitary) lesion – atypical network and atypical black dots, and a great deal of regression over more then 50% of the lesion.
    Excise with 2mm margins – suspected melanoma.

  5. I think this is a great case! It is on the blog so we all take it seriously. I wonder how many mainstream GPs in Australia would “see” this and do something about it? I bet not many. It could so easily be a solar lentigo – it does not jump out clinically as Annie says. The dermoscopy is more suspicious than the clinical and scores 2 on 3-point checklist I think (asymmetry and multiple network types). So, it needs biopsy. For me, if it is flat (and it looks like it is) I would do a shave excision (ensuring I remove it all), because this is quick to do, and I am confident in that procedure. Of course, wider excision is next. thanks to all

  6. Just seen this presentation. What a great and sobering learning tool for skin cancer doctors.
    If you use Chaos and Clues you will pick up the chaos signs( asymmetry of both color and structure) and several signs of malignancy follow. So some form of biopsy to establish a diagnosis(I like the synoptic report) then follows a decision on further surgical management.
    In this anatomical area I would refer to a plastic surgeon as margin guidelines suggest at least 5mm surgical margins.Further decision needed on who does long term follow up as, despite its appearance this is actually an invasive melanoma.

  7. Polygons, dermoscopic grey, atypical dermoscopic island and minor regression central. needs shave biopsy and appears to be finally a SSM

  8. Not a jump our lesion but there is clear asymmetry; the odd areas in the NE has polygons, grey, black dots; that should lead to shave or excision biopsy as it meets the chaos and clues criteria for excision.
    It now requires a 1cm margin as its invasive, right over the shin, the least yielding site, may need a keystone or skin graft. Halo graft is contraindicated for melanoma