Case discussion: How would you treat this patient? [7 January]

This week we have an engaging case. What do you make of the clinical and dermoscopic images below? What do you think of each and 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

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8 comments on “Case discussion: How would you treat this patient? [7 January]

  1. without history and context, but clearly an older pt in photo with sun damaged skin;
    this lesion is asymmetrical of shape, asymmetrical with colour, multi colours, multi patterns or networks with hyperpigmented eccentric areas and regression so is suspicious.
    ? blue grey veil/structures at 6 o’clock and ?? blue clod/globule and are they spoke wheels on the left hand side?
    DDx: melanoma, BCC,
    as I am a nurse I would refer for excision/biopsy

  2. Single standout lesion in a skin sun damaged with chaos in colour. No specific pattern. I would excise to rule out MM.

  3. Chaotic lesion. Dermascopic grey. Peripheral dots and pseudopods.
    Interesting it has cyst like structures as well. So Malignant melanoma with seb k as well.
    Excise with 2 mm margins.

  4. Needs excision due to chaos, polygons, dermoscopic grey.
    Looks tricky, risk of causing erbs palsy?
    Uncertain whether a shave or excision is better here.

  5. Happy new year to everyone. An easy case to start the year – in that this is clearly “suspicious” and needs a biopsy. A shave is OK as it is small and flat (and quick and easy to do). The diagnosis is “MIS” (just), and the latest national guidelines provide the following advice for treatment of this lesion:

    After initial excision biopsy, the radial excision margins, measured clinically from the edge of the melanoma, should be 5-10 mm (measured with good lighting and magnification) with the aim of achieving complete histological clearance.
    Melanoma in situ of non-lentigo maligna type is likely to be completely excised with 5mm margins whereas lentigo maligna may require wider excision. Minimum clearances from all margins should be stated/assessed. Consideration should be given to further excision if necessary; positive histological margins are unacceptable.

  6. Chaotic lesion with dark structureless areas, and peripheral regression areas particularly at 6-8 O’ Clock. Gray globulules peripherally indicate growing lesion. From the shape of the lesion, it suggests lintigo maligna arising in a solar lintigo lesion.
    In view of the history,I would re-excise with one cm margin.