Case discussion: How would you treat this patient? [18 March]

This week we have an engaging case. No clinical image or history.

What do you make of the dermoscopic image below? How would you biopsy?

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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7 comments on “Case discussion: How would you treat this patient? [18 March]

  1. I don’t know. It’s not clear and out of focus. However there is two dark areas but can’t see any specific pattern. I would take a biopsy to rule out any malignancy though.

  2. peripheral demoscopic islands needs shave excision to rule out Superficial spreading melanoma which is my DD here

  3. Definite lack of symmetry. three colours (black, dark brown, light brown). Merges with pigmentation of skin around so a bit hard to tell where true border is.
    My DD Melanoma in situ / superficial spreading melanoma vs regressing neavus vs flat seb K

    If we are trying to differentiate between a neavus and melanoma I assume the pathologist will need the whole lesion (or a very thick shave)
    I assume a punch or two could confirm that a seb K (or at least a non melanocytic lesion).

    Will be interested in histology, anothers opinions re biopsy options.

  4. Definite lack of symmetry. three colours (black, dark brown, light brown). Merges with pigmentation of skin around so a bit hard to tell where true border is. I am not totally convinced re radial lines
    My DD Melanoma in situ / superficial spreading melanoma vs regressing neavus vs flat seb K

    If we are trying to differentiate between a neavus and melanoma I assume the pathologist will need the whole lesion (or a very thick shave)
    I assume a punch or two could confirm that a seb K (or at least a non melanocytic lesion).

    Will be interested in histology, anothers opinions re biopsy options.

  5. Could be a melanoma arising from a Solar lentigo. Structureless area in centre, asymmetrical shape, atypical structures on the left. I would recommend excision

  6. This lesion is definitely showing chaos but could not find any clues. Will decide for excisional biopsy with 2 mm margin.