Case discussion: How would you treat this patient? [22 June]
In this week’s discussion, we present a case from Dr Christopher Jensen, featuring:
- 69 year-old male patient
- New pigmented lesion on his right cheek
- History of invasive melanoma and melanoma in situ, 20 years and 1 year ago respectively
What do you make of these images? What would you do, if anything?
Pathology report is:
Pbx R cheek
Right cheek: A 4mm punch of skin, 5mm deep. Bisected. 2-1A.
Sun damaged skin with subcutis. There are large epithelioid melanocytes along the junction in a lentiginous pattern extending into follicular epithelium and showing focal pagetoid infiltration. Dermal invasion at a depth of 0.87 mm is present.
PRAME is negative.
Right cheek, biopsy:
Diagnosis: Malignant melanoma
Subtype: Superficial spreading
Breslow Tumour thickness: 0.9 mm
Mitotic rate (/mm2): Nil
Level of invasion (Clark): Level IV
Vascular invasion: Absent
Tumour infiltrating lymphocytes: Moderate infiltration at the peripheries
Associated benign melanocytic lesion: Absent
We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.