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1800 867 1390Case discussion: How would you treat this patient? [18 February]
This week we have an engaging case from Dr Tim Aung. A 56-year-old male with history of melanoma presented with a growing pigmented lesion left preauricular over 6-12 months.
Here are the clinical and dermoscopy images. What is your differential diagnosis, and how would you biopsy?
Update:
These are the results from the pathology report. What do you think now? How would you treat further?
We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.
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1300 856 695
+44 203 514 0688
1800 867 1390
Non chaotic lesion. Don’t see any clues. I think it’s a PSK or lentigo.
Small shave of whole lesion would heal well.
I see grey dots and a black area suspicion for lentigo maligna so a complete shave excision for histopatholigy.
seborrheic keratosis with moth eaten edges and no concerning patterns to shave. leave it alone & reassure the patient. no biopsy needed
There is a darker area at the lower right side. No other patterns can be seen. Based on the history Iof MM I would shave just to make sure.
Interesting lesion. looks like a benign solar lentigo with a darker ??SebK developing on the side. But this darker area has less well defined borders as would be expected with a SebK
And on the enlarged dermoscopic image (when further enlarged by clicking on it) there seems to be a pattern of brown dots all over the background of a (seemingly) structureless brown lesion.
Curious to hear what the result of the shave is. Not sure if I would have picked it up.
Biopsy warranted
– Apperance of solar lentigo with a dermoscopic island feature.
? melanoma arising in solar lentigo
What a surprise. PSCC. The biopsy said it’s excision is clear. I don’t know what else can be done. Is the LN clear.
Ebti, Do you mean LN (Lymph node)?
Given Intraepidermal (confined in epidermis, lesser form of SCC), no need to bother such extent except in MM with ^ Breslow thickness.
This is indeed a challenging dermoscopic features. I like most of you, inclined on LM/LMM in view of dark and dense pigmented clods in the background of multiple brown rings plus PHx of MM. To ensure I also stressed pathologist by sending macro and dermoscopic photos.
In retrospect, there is v/s signs suggestive of IEC (Bowen disease) if you zoomed the picture. Let me credit to those who suggested to zoom. In this case v/s sign was masked by homogeneous brown rings which surround the pale oval (follicular opening)
Clustered or coiled v/s + scale (keratosis)> IEC
the above plus + Brown dots/globules > pigmented IEC.
https://dermoscopedia.org/Bowen%27s_disease
https://www.ncbi.nlm.nih.gov/pubmed/15214896
I see chaos and worry about a melanoma. There are streaks at the periphery of the darker spot as well as obliteration of the follicular openings and grey color. It does not seem at all like an SCC. I’d ask the pathologist to review it.
I see chaos and woory about a melanoma. There are streaks at the periphery of the darker spot as well as obliteration of the follicular openings and grey color. It does not seem at all like an SCC. I’d ask the pathologist to review it.
Great case from Tim – thanks Tim. A rarity for sure. I think the key lesson here is that this lesion MUST be biopsied. Why? Because you simply cannot be sure what the diagnosis is from clinical view, and from dermoscopy view. Yes, you sure can list them – ML, SK, AK, etc etc. BUT you cannot be sure which one it is – it could be any. So, biopsy needed.