Case discussion: How would you treat this patient? [4 November]
This week we have an interesting case from Dr Colin Armstrong. An 85-year-old male presented for a skin check and suspected for melanoma. Please review the clinical and dermoscopic images below.
How would you biopsy this suspicious pigmented lesion on the chest? What is your differential diagnosis?
These are the results from the pathology report. What are the pros and cons of the treatment options here?
SHAVE BIOPSY RIGHT MID CHEST:
– PIGMENTED INTRAEPIDERMAL CARCINOMA.
– COEXISTING, SMALL JUNCTIONAL LENTIGINOUS NAEVUS AND SEBORRHOEIC KERATOSIS.
Histopathology – shave biopsy, right mid chest ?atypical naevus excl melanoma (polygons).
Labelled ‘R mid chest’. A 15 x 10 x 1mm shaved skin specimen with a dark brown macule 8 x 6mm. 1A-1B 3TS each.
These sections of skin show several pathologies. There is pigmented intra epidermal carcinoma. Deep to the in-situ disease is a lichenoid inflammatory cell infiltrate and there is associated patchy pigment incontinence within the papillary dermis. There is no invasive malignancy. The in-situ disease appears clear of the shave edges in the sections examined. Adjacent to this is a small junctional lentiginous naevus which also appears clear of the shave edges. There is also a small seborrhoeic keratosis towards one peripheral edge of the shave.
We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.