Case discussion: How would you treat this patient? [3 February]

We have an interesting case from Dr Sivateja Mukkamala this week. There was no history and the lesion was found during a skin check. Please examine the dermoscopic image below.

What dermoscopic features do you see? What is the differential, and what would you do?

Case discussion    Case discussion

Update:

Here is the result. What would you do next?

Result was Superficial Spreading Malignant Melanoma, Breslow Thickness 0.7mm, Clark Level 3.

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17 comments on “Case discussion: How would you treat this patient? [3 February]

  1. The Lesion is asymmetrical with indistinct margins central area of ulceration/erosion. I am unable to determine whether there are any globules. However, the lesion appears to be polychromatic. I would make a diagnsis of a Malignant Melanoma.

  2. looks like a melanoma arising within a preexistent seborrheic keratosis, needs excision with 3mm margins for histopath

  3. Classic ugly duckling to naked eye exam.
    Dermatoscopically chaos,with asymmetry of both structure and colour in a melanocytic lesion.
    Several clues to malignancy,including lines radial segmental,peripheral brown dots and clods,grey/blue structures(largely under surface scale),and thick lines reticular.
    Pretty classic melanoma,excise with 2mm margins,then proceed with wider local excision based on dermatopathology.Could well be an invasive melanoma.If so,would need synoptic report from pathologist

  4. this lesion has got enough clues and caos
    need wide excision,if not confident refer to plastic surgeon
    i think is melanoma

  5. pigmented lesion with chaos. There are a few clues pseudopods and radial streaking. Need excision biopsy to exclude a melanoma.

  6. chaos in structure and colour
    radial lines
    peripheral brown dots
    psuedopods
    Imp: melanoma
    excise with at least 2 mm border

  7. “ugly duckling”, chaos of colours, reticular pattern and structureless, chaos of border abruptness
    clues include radial lines peripheral segmental, ?pseudopods, blue/grey
    high index suspicion melanoma
    excision with minimum 2mm margins to deep fascia

  8. Initial Excision done with 2 mm margin
    Synoptic Report: Invasive Melanoma ( Superficial Spreading type Clark Level 3, Breslow Thickness 0.7mm, Lymphovascular Invasion Absent

    Recalled patient a week later and performed wide excision with wider and deeper margins 1.2 cm, No residual melanocytic neoplasia

  9. I think this is a great case. Clinically this is obviously an ugly duckling. What is it? Don’t know, can’t sure. Both benign and suspicious diagnoses are plausible. Therefore biopsy – 2mm excision biopsy. I don’t see any definitive dermoscopic criteria