Case discussion: How would you treat this patient? [6 April]

This week, we present a case from Dr Mohammad Sharier, which features a 20 year-old male patient with a 3mm pigmented naevus on the tip of his left second toe. He has noticed it over the last 4 weeks.

  • What is your assessment of the dermoscopic image?
  • What would you do next?
  • Why?

Case discussion

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18 comments on “Case discussion: How would you treat this patient? [6 April]

  1. i definitely bx it new lesion arising, and the pigmentation does not arise from the groove, it is difinitely suspicious.

  2. Hi. Do you think it could be blood from trauma? Looks like the right place for it. Similar to a talon noir? Looks red rather than brown and globular. Plays sport? Small or por fitting shoes? If in doubt biopsy it.

  3. The main area is 4mm but there are surrounding seperate areas too – which makes subcorneal bleeding from trauma more likely. There is also deep seated yellow under and around lesion, again in favor of trauma. THe lesion is red and there is no distinguishable furrow or ridge pattern. Review shoes and ensure no trauma continues as it would distort the clinical concern further. Short term follow up in 4 weeks with dermatoscopy should suffice. If the patient is convinced that trauma is not a feasible cause, a biopsy should be done. One option to consider given the deeper bruising, is exosthosis off the distal digit – this can easily be checked with an XR

  4. This is a hematoma. The dermoscopic picture does not show a furrow or ridge pattern (that you would see in a nevus or melanoma) , or brown pigment.
    The best plan would be reassurance and follow up in 4 more weeks.(may take longer to resolve)
    Even without history of trauma , that is the most likely cause!!

  5. This is a hematoma. The dermoscopic picture does not show a furrow or ridge pattern (that you would see in a nevus or melanoma) , or brown pigment.
    The best plan would be reassurance and follow up in 4 more weeks.(may take even longer to resolve)
    Even without history of trauma , that is the most likely cause!!

  6. 1 .This is subcorneal hematoma.
    clue – short history , sudden appearance , red blotches

    2. It requires no treatment – will resolve on its own- patient needs to be reassured.

  7. short history
    young age and colour and location of lesion more in favour of talon noir.
    it can be follow up in three to four weeks
    if not scab off then will approach for biopsy

  8. short history
    young age and color and location of lesion more in favor of talon noir.
    it can be follow up in three to four weeks
    if not scab off then will approach for biopsy

  9. Subcorneal hemorrhage.
    Red to light brown clods and dots in lines, orange periphery.
    No treatment.
    Supervision after 4 weeks, up to 3 month in case of thick keratin layer.

  10. Blink diagnsosis of subcorneal hemmorraghe. If no clear history of an injury, I`d consider reviewing this after 6 weeks to see if it resolves and make sure there is no underlying other lesion.

  11. Thank you . I think this is a sub corneal haematoma . I cant see any signs consistent with a melanocytic lesion. There may not be a definite history of acute trauma but the adjacent nail certainly looks traumatised.
    I would reassure, watch for signs of resolution over 4 to six weeks. If any persisting concerns an initial shave biopsy.

  12. It looks to me to be a subcorneal haemorrhage- clues being the red lacunes seen and peripheral smaller area indicating haemorrhage .
    I would advise of this and reassure the patient
    and advise the patient that it should gradually fade and disappear over the next 1 to 2 weeks, however if the patient still has any new concerns or it doesn’t disappear over a short time period, they should return for a further check and examination .

  13. Yes, this is definitely a subcorneal haemorrhage. Typical appearance and is red. Definitely need to make sure that it has disappeared in a few weeks – other option is to scrape this off using a blade – it usually comes off easily and is seen to be blood.