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

This week we discuss a compelling case from Dr Mokesh Raj of a man aged 60+ with sun damaged skin – a common presentation in both skin cancer clinics and general practice settings in Australia.

There is no history or clinical picture. What is your opinion on the dermoscopy image? Are there any features or criteria of note?

Would you biopsy this lesion from what you see here? Why? How?

Case discussion

Update:

These are the results from the pathology report. What would you do next?
Specimen.
SKIN LESION LEFT CHEEKGross Description.
The specimen consists of a skin ellipse 7 x 4 x 2 mm with a central brown macule 5 x 3 mm. 3 NR 3L

Microscopy.
The epidermis shows scattered foci of atrophy and the dermis shows elastosis. Extending diffusely along basal epidermis and down follicular infundibula are melanocytes with enlarged, hyperchromatic nuclei. No dermal invasion is identified. The lesion focally involves a radial margin.

MALIGNANT MELANOMA IN SITU ON SUN DAMAGED SKIN (LENTIGO MALIGNA), FOCALLY INVOLVING A RADIAL MARGIN

We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.

MORE CASE DISCUSSIONS


Interested in Skin Cancer Medicine?

The HealthCert Professional Diploma programs offer foundation to advanced training in skin cancer medicine, skin cancer surgery or dermoscopy and provide an essential step towards subspecialisation. All programs are university quality-assured, CPD-accredited and count towards multiple Master degree pathways and clinical attachment programs in Australia and overseas. The programs are delivered online and/or face-to-face across most major cities of Australia.

Courses in Skin Cancer Medicine:
Melbourne | Gold Coast | Brisbane | Sydney | Online

Courses in Skin Cancer Surgery:
Melbourne | Gold Coast | Brisbane | Sydney

Online courses in Dermoscopy:
Start studies anytime. Join one of 3 Cohorts.

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

  1. has dermoscopic grey and regression with peripheral dermoscopic island pigmentation, shave biopsy will be enough. most likely a highly dysplastic nevus

  2. Chaos of colours and structures. Thick reticular lines asymmetrically distributed with some grey area.
    Which warrant a biopsy.
    However, some of Clark nevi’s can present with similar grey and [pigmented network. Few hairs come through the lesion, which suggests this lesion could be benign as well.
    Hard one to decide, to excise or not.

  3. on careful view, the dermoscopy is clear here – score at least. 2 on 3 point (asymmetry and atypical network) – requires 2mm excision biopsy. now needs excision with 5mm margins

  4. Chaos in structure and colour, Atypical network at most areas of upper part of lesion.
    Excision biopsy with 2 mm margin.

  5. Needs excisions biopsy (2mm margin) after discussion with patient regards to facial scarring. Most patients are just happy to get rid of the lesion but some are unrealistic about cosmetic outcomes and they will need referral to ensure they feel they have had the best chance removal plus good scar (whether they actually get it or not!)

  6. Chaos of structure, colour and border. Dermatoscopically gray on the face. Initial 2mm margin excision biopsy. Pathology on this mandates 5 mm clearance margin on re-excision. Possibly a bit more than this given that the original excision biopsy had melanoma at the margin

  7. Excise with 5mm margin. As LM may extend beyond the clinical margins in this sun damaged skin with adnexal involvement and “bread-loafing ” has a 9%
    incomplete margin assessment, mapped serial excision or
    Moh’s by a qualified practitioner may be required.

Leave a Reply

Your email address will not be published. Required fields are marked *