Case discussion: How would you treat this patient? [30 March]

This week, we present another case from Dr Tim Aung, which features a 60 year-old male patient with an ugly duckling identified during skin check.

  • What is your assessment of the clinical and dermoscopic images
  • What would you do next?
  • Why?

Case discussion    Case discussion

Update:

Here are the results. What next?

Case discussion

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23 comments on “Case discussion: How would you treat this patient? [30 March]

  1. I would say this looks suspicious – asymmetrical with atypical pigment network. I would perform excision biopsy with 2mm margins.

  2. Without clinical history I don’t think it looks suspicious; 1 network, no blue grey colours, close to symmetrical in 4/10 plane. Would be a different approach if this was brought to my attention as a new changing lesion, or if it obviously stood out as an ugly duckling lesion.

  3. Brown Unifrom Colour, Symmetrical pattern except for darker pigmentation and thkcer network with dots at 5 O clock. Could be a changing nevus but no peripheral changes or pseudopods noted at 5 O clock in relation to minor changes. Depending on history if there is a concern excise with 2mm margins or otherwise initially 3 monthly Dermatoscopy and Monitoring

  4. Assymetrical. Streaks at right lateral lower. Rhomboid structures at mid upper and to left upper. Also white lines. Need excision biopsy with 2 mm margin

  5. A bit of assymetry in colours /atypical network-(2/3) I will excise with 2 mm margin. Lesion most likely dysplastic naevus but certainly merit biopsy in a 60 year old man

  6. Homogeneous pattern in the center, reticular rim on the upper border and some scattered white dots resemble a milia-like cysts looks like a seborrheic keratosis at first blink. Therefore, black clod on the right, some streaming on the low border, few grey dots on 5 – 6 o’clock are signs suspicious for MIS. If this lesion is ugly and recent, with fast growth it should be excised. Otherwise, follow up in 3 month.

    1. Looks like an ugly duckling. Looks suspicious, asymmetry, atypical network. Err on side of caution and remove with excision for diagnosis.

  7. Asymmetrical Colour with darker area at 5 O’Clock area. There are thicker reticular lines at the same area with some peripheral black dots.
    Suspicious using both Three Point Check list : Score 2 Or Chaos and Clues: Chaos and peripheral black dots and thick reticular lines.
    I would excise it.

  8. Chaotic lesion with segmental peripheral reticular pattern and central homogeneous pattern. Very disimilar to other lesions seen in the macro photo. If there was a history suggest a stable lesion then short term surveillance otherwise excise with 2mm margin.

  9. Small flat looking PSL,hairy area(?back or chest).Chaotic(asymmetry of colour,lower pole darker)
    No clues to malignancy except thick lines,reticular at lower pole.
    Can’t name it,so should be excised with 2 mm margins.
    Possibly a very early melanoma arising in a pre existing naevus

  10. 60 years old on the trunk .
    Looks like multi component neavi , a clue thick lines
    I will take excision biopsy with 2 mm margin

  11. for me, when I saw the images I thought that clinical was suspicious and the dermoscopy was a clear 2/3 on 3-point (asymmetry and abnormal network). that leads to a 2mm excision biopsy. In situ melanoma confirmed leads to a 5mm formal excision

  12. Clinically I thought this was a bcc. On dermoscopy there was arborizing blood vessels but the white circles made me suspicious that it may be a scc. Would like to know the dermoscopy finding are consistent with what. Thanks