Case discussion: How would you treat this patient? [14 September]

This week, we have an interesting case discussion from Dr Emanuela Tura featuring:

  • 28 year-old female patient
  • Growing lesion on her back

Please review the below images. What is your evaluation, and what would you do next (if anything)?

Case discussion

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24 comments on “Case discussion: How would you treat this patient? [14 September]

  1. there are yellow colour fat droplets and some reticular structures
    the colour changes with pink, brown dark and light areas
    it has a assymetrical margin too.

    I believe it is a SK and will take a good hx and ask her to come after 6 months, save a photo in the file

  2. The history alone is concerning. Additionally there is chaos with clues on structureless areas; excisional biopsy recommended.

  3. This is a large lesion, larger than most others on her back; it is chaotic, with more than one colour and more than one pattern, and has the clue of a large eccentric structureless area, and warrants an excisional biopsy with a 2mm margin

  4. Pictures are not very clear but you’ve said growing lesion. Looks to be chaos, asymmetry, amorphous area and ? some thickened pigment bottom right. Macroscopically looks like she has multiple naevi which are all a bit different. On balance I would excise with 2mm margin.

  5. Growing lesions is a normal finding in young patients particularly those with multiple dysplastic nevi. The lesion looks asymmetric with a structurless area. I really do not know if it is different from the other moles of this patient. Any previous dermoscopic pictures? I would excise this lesion given that there is no further information

  6. Chaos in pattern and choas in colour with eccentric structureless area – Needs biopsy esp. if it is growing.
    Differential – ? Inflamed reticulated seb.k ? Dysplastic naevus

  7. Hi All, A wide range of views here. This is what I would do: 1) full skin check – is this the only lesion like this, or does she have more (there is one similar above it), 2) what is her level of anxiety or concern? At her age, a growing lesion is normal, but growing how much? I see nothing on dermoscopy that makes me think melanoma. 3-point c heck list is 0 or 1 at most = benign. Some of you are saying things like “chaos and some clues, or no clues”. You are referring to the chaos and clues algorithm, so you need to use the full algorithm, not just part of it! For me, this is benign and if the patient as comfortable I would take a photo and see her again in 3m and 6m. Let’s be clear – it is likely to change in that time frame anyway, so what am I “monitoring for”? I am looking for more than just “growth”, I am looking for a change in the nature of the lesion. If she had multiple lesions that I looked like this, I would not “monitor”.

  8. – No sinister features. Reassure the patient. But if patient concerns I excise it after explaining of complication.

  9. Righton the spine – so trauma of the lesion can obscure it .
    I think it looks benign . Could monitor and review for growth at 3 months

  10. Looks asymmetrical/ chaotic, possibly some incomplete polygons, it has an eccentric structureless area, pink flush. I would excise as ? Melanoma ? Dysplastic naevi