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1800 867 1390Case 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?
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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1300 856 695
+44 203 514 0688
1800 867 1390
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.
There is chaos of shape and color. The likely diagnosis is malignant melanoma. Surgical excision is indicated.
PSL with asymmetrical border, colour variation, distinct black clumps. ? Melanoma
looks like a melanoma arising within a preexistent seborrheic keratosis, needs excision with 3mm margins for histopath
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
this lesion has got enough clues and caos
need wide excision,if not confident refer to plastic surgeon
i think is melanoma
Highly suspicious for a malignant melanoma.
Excise with 2mm clinical margins.
pigmented lesion with chaos. There are a few clues pseudopods and radial streaking. Need excision biopsy to exclude a melanoma.
Suspicious pigmented lesion with chaos for colour and pattern
2mm excision biopsy or shave biopsy
chaos in structure and colour
radial lines
peripheral brown dots
psuedopods
Imp: melanoma
excise with at least 2 mm border
“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
Given features mentioned on dermascope and the high probability of malignancy,excision with 5mm margin
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
This lesion is suspecious as it has irregular pattern and whitish discolouration
I would treat this lesion with excision biopsy with safety margin.
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
Result was Superficial Spreading Malignant Melanoma, Breslow Thickness 0.7mm, Clark Level 3
This should have a wider excision with 1cm clearance
very clear diagnosis: treatment options:
check nodes : send to Melanoma clinic
or if you handle it : > 1cm wide excision for lesion < 1mm deep