Case discussion: How would you treat this patient? [27 January]
This week, we discuss an interesting case from Dr Mokesh Raj. A 60+ year-old patient reported that his lesion has been getting darker over the last 6 months. Please examine the dermoscopic image below.
How would you evaluate this? If you were to do anything next, what would you do?
These are the results from the pathology report. What would you do next?
SKIN LESION RIGHT CHEEK
The specimen consists of a skin ellipse 40 x 15 x 5 mm with an eccentric irregular variegated lesion 20 x 11 mm. X R 3L
Sections show severely sun damaged skin to subcutis in which there are features of an in situ melanoma. This is characterised by a proliferation of atypical melanocytes both singly and in nests along the basal layer of the epidermis. There is focal pagetoid spread and extension around adnexal structures but no evidence of dermal invasion is seen. The dermis contains a heavy chronic inflammatory cell infiltrate with scattered melanophages. The lesion appears to extend to within 0.4 mm of the nearest circumferential excision margin.
SKIN, RIGHT CHEEK: IN SITU MELANOMA, NARROWLY EXCISED.
We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.