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1800 867 1390Case discussion: How would you treat this patient? [23 March]
In this week’s case from Dr Tim Aung, a patient presented for a skin check:
- 50 year-old male
- Ugly duckling identified
What is your assessment of the clinical and dermoscopic images, and what would you do next? Why?
Update:
Here are the results. What next?
. 
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1300 856 695
+44 203 514 0688
1800 867 1390
Atypical network and white scar like structure
A suspicious lesion for melanoma
Excision biopsy
I would like to know whether this patient was aware of this/ was this lesion present before hand and for how long.
The sinister features are the age, and if the patient indicates that he was not aware of it.
In terms of the lesion I did not see any feature to redflag this lesion. and if i do not know the demographics i will consider it benign
Symmetrical
Atypical pigmentations
Blue dot
3 point checklist -2
Mx-excision biopsy
General thickened network with an eccentric area of dense pigmentation. Melanoma possible. Requires excision
Compound melanocytic nevi, leave it alone
benign, mildly dysplastic. excision biopsy recommended to exclude severely DN or MM is
Reticular network on scalp so nevus unlikely. Thick lines fading to periphery in a uniform fashion. Uniform with no asymmetry except for structure top right. Solar keratosis becoming seb keratosis. Can observe
Agree with Mikhail
Atypical pigment network, white scar like structure, asymmetry in structure, likely melanoma.
Atypical pigment network.
white scar like area ? Asymmetry of structure? … melanoma or dysplastic naevus.
Needs excision biopsy.
Atypical pigment network, asymmetry.
Clinically ugly duckling sign.
Excisional biopsy DDX: Dyspalstic nevus vs Melanoma
I suspect this in on the front of his hairy chest? If so, I`d leave it alone – symmetrical compound naevus. History of change possibly could make me change my mind. Short term f/u after 3 months could be an option.
?The image might also suggest a scalp location ?? – if so, cut it out, suspected melanoma.
suspecious lesion with asymmetrical pattern with dark area & some scarring effect
Advised regard excision biopsy
I don’t have much to add here. For me the dermoscopy was tricky – I scored it 1 for asymmetry, so called it benign.