Case discussion: How would you treat this patient? [21 October]
This week we have another engaging case. A 65-year-old Caucasian female with no history of melanoma presented for excision of a cyst on her back. A full skin check was done and a pigmented skin lesion was noted on her lower back.
How would you respond to this presentation?
How would you manage a patient with these findings? Please share your feedback.
Microscopic: 1. Sections are of skin, including subcutis, and show malignant melanoma: TYPE – Superficial spreading CELL TYPE – Naevoid to epithelioid, moderate tending to moderate-severe cytological atypia, moderate increase in pale cytoplasm. PIGMENT – Mild ULCERATION – Not evident CLARK LEVEL – 3; expanding and tending to fill papillary dermis. BRESLOW THICKNESS – 0.68mm MITOTIC RATE – No dermal mitotic figures identified. TUMOUR INFILTRATING LYMPHOCYTES – Focal REGRESSION – No significant regression fibrosis. PERINEURAL OR LYMPHOVASCULAR INVASION – Not identified SATELLITE DEPOSITS – Not identified COMPLETENESS OF EXCISION – 1mm from both transverse margins, >5mm from longitudinal ends.
We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.