Case discussion: How would you treat this patient? [25 February]

This week we have an interesting case. There is no history for this patient here, but assume this is an adult.

What do you make of the clinical and dermoscopic images below? How would you biopsy?

Case discussion      Case discussion

Update:

These are the results from the pathology report. What do you think now? How would you treat further?

Case discussion

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12 comments on “Case discussion: How would you treat this patient? [25 February]

  1. Pigmented skin lesion with areas of darker pimentation and smaller clods . Area of change in a pigmented naevus. Excise with 2 mm margins await biopsy results and plan accordingly

  2. Asymmetry of both color and structure i.e. chaos
    Looks to be 2 or 3 clues to malignancy (pseudopods,segmental eccentric structureless area,possibly a grey/blue structure )

    I would do a full excision biopsy as the lesion and history demand dermatopathology.

  3. clinical view :no history but solo lesion on “clean” skin ?on limb, asymmetric pigmented lesion

    Dermoscopy: asymmetry structures, colours and border; white clods regularly distributed, eccentric structureless / regression, radial lines/pseudopods, /grey structures, mild halo in surrounding skin yellowy/pink

    impression: suspect lesion with clues to melanoma

    DDx: melanoma, irritated seb K,

    plan: solo lesion with no history available of change or new?? biopsy and or excise with 2mm margins

  4. A lonely pigmented lesion- Chaotic (asymmetric and more than 1 colour- black, brown, pale/pink).
    Clues: black/dark clods with follicular obliteration, and eccentric structureless is enough to suspect for MM, and to proceed a 2mm excisional biopsy and go from there. Pseudopods are not clear enough.

  5. im not convinced it is malignant, looks like a seborrheic keratosis with sharp demarcation and milia, the dermoscopy is not sharp to comment as well. leave it alone and reasses in 3 months time

  6. A little chaotic but no other clues I could see. I might do a 3 monthly surveillance and then biopsy if any changes noted in the first instance.

  7. for me, without any history, this is such a lonely lesion, and it looks so unusual, I would have to do an excision biopsy. Then, with the pathology of Spitz, I would be glad I had done that, and with a 2mm excision biopsy done, I would leave Ita that