Case discussion: How would you treat this patient? [2 March]

This week, we have a case from Dr Sivateja Mukkamala featuring an 85-year-old male who presented for a skin lesion check on his leg. During the same consultation a full check was performed, which identified a suspicious pigmented lesion on the back that he was previously unaware of.

Here is the dermoscopy picture – what do you think and what would you do?

Case discussion

Update:

Pathology: Invasive Malignant Melanoma Brelsow Thickness 0.3mm Clark Level 2. 

What next?

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19 comments on “Case discussion: How would you treat this patient? [2 March]

  1. Dysplastic nevus with central regression and polygon. would need a shave biopsy or excision biopsy but i would think that it is most likely a junctional nevus than melanoma

  2. Asymmetrical regressing lesion with clues to malignancy (grey veil and thick lines reticular). Unable to see the vessel pattern properly but could be dot vessels at 12 o’ clock. Would do a shave or excision biopsy with 2mm margin.

  3. I see blue grey veil also, asymmetry but in a background where network pattern still visible. Excisional biopsy would be my plan.

  4. Excision biopsy with 2mm margins. Clinically suspicious for melanoma with segmental radial lines, blue-grey colour and area of atypical pigment network. Heavily solar damaged skin

  5. Looks suspicious . 3/3 in 3 point check list . Requires excision biopsy with at least 3-4 mm margin. Wait for histology report and plan reexcision. Looks like melanoma.

  6. This is a chaotic lesion with thickened lines reticular and regression. It requires an excision with a 2mm margin. The trick here is to determine where the lesion starts and finishes.

  7. Chaotic lesion with pink and brown , slightly irregular net work with something that may be streaks but are more likely to be `fat fingers` and some nice added permanent marker pigment 😉 . Severely sun damaged skin in the background. Bit unclear if the pink/white area in the R side of the image is part of the lesion – one could imaging to see some negative network there? My initial approach would be to compare with other lesions on his back – does he have 10 or 20 more with a similar pattern ? or is it an ugly duckling?- if so a biopsy would be advisable – with a hint of blue white veil and grey in the lesion, I`d prefer to do an excision over a shave. I guess it will tell us this is an irritated SebK (?)

  8. Looks chaotic pigmented lesion think reticular lines
    Plus blue veil periphery? Melanoma in situ….
    For excision always biopsy with at least 2mm

  9. Pink and brown make me frown
    Chaos of structure
    Chaos of border
    Chaos of color
    Asymetrical sructure less area ? Regression
    Radial lines segmental
    DDx superficial spreading melanoma, pigmented SCC
    Excision biopsy with 2mm margins to sub cut is to rule out melanoma

  10. My comment on this case, reflecting the above comments is this 1) there is no such thing as a dysplastic nevus, and 2) certainly any suspicious pigmented lesion in a person this age is melanoma until proven otherwise.