Case discussion: How would you treat this patient? [10 December]

This week we have an interesting case. What do you make of the dermoscopic images here? No history, just clinical findings. What do you think? (Not everything is a skin cancer!) Is this? Would you biopsy / why?

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

  1. Irregular borders, assymetrical pattern, difficult to see pigment network, no white or blue features. I’d want to see more with dermatoscope to assess the pigment network and compare with other lesions in the same area.

  2. Are there other lesions like this

    Asymmetry of colour and structure

    I cannot diagnose a SebK with confidence
    I cannot Dx a Dermato-fibroma
    I cannot diagnose a BCC

    I am not sure of excluding a melanoma

    I WILL DO A SHAVE BIOPSY.

  3. Dermoscopically: A solitary pigmented lesion with not much Chaos & Clues. Nevertheless asymmetric in shape with > one colour. Dark clods (^^ Melanocytes proliferation with obliteration of follicles/network ) and subtle peripheral brown dots are causing Melanoma or non-Melanoma (Naevus).
    Yes, not everything is a skin cancer, but don’t know to how to name (Dx), especially sinister MM cannot be ruled out. Thus to biopsy by a standard 2mm margin excisional and go from there. If shaved, ensure inclusion of deep dermal as well.
    Hope this is for end of 2018, and Wishing Merry Xmas and Happy New Year to Professor Wilkinson and every colleagues here.

  4. The lesion is chaotic, peripheral structureless, thats the whole interior part, network effaced in many places, gray.
    Melanoma, excision biopsy.

  5. I think this is a benign nevus. I see a reticular and structureless pattern, No chaos. No clues to melanoma . I would cut it out in a 70 year old since you would not expect reticular nevi in the elderly to file out malignancy

  6. with the 3 point checklist, the dermatoscopic picture looks like its asymmetrical, I can see the pigment pattern irregular, but no b/w structures, scores 2/3, will biopsy it!

  7. peripheral reticular pattern, structureless centre, some peripheral dots, slightly greyish veil at 9 O’clock.
    suggestive of melanoma arising in a naevus.
    I would consider wide excision in view of the histology uncertainty.

  8. So, we end the year with a case that gives me no hope! How can this be a melanoma? Honestly, I don’t see any features that make this a melanoma. Maybe the clinical history or the clinical appearance would have caught my attention? I don’t know. I guess the point here is that we can’t catch everything – we can only do our best. That is the last case for the year. Thank you to all for all your input over the year. We do it all again in 2019 so please send cases through. All best wishes. DW

  9. The pathology report: Severe dysplastic nevus. Should be treated as a melanoma in situ.
    Excision to obtain a margin of 10mm.
    The only problem here is the margins are subtle. I will warn the patient a re-excision may be possible if adequate margins are not achieved.