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1800 867 1390Case 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)?
We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.
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1300 856 695
+44 203 514 0688
1800 867 1390
looks disorganized with variable pigment pattern
excise
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
Chaotic
Brown dots
Structureless brown
Excise
?melanoma
Chaos present. Little clues. Must excise 2mm margins.
excise
not very clear dermatoscopy pic, I would probably take more history and watch, I have mole max so serial pic would help
Chaos ? Melanoma Excision biopsy.
The history alone is concerning. Additionally there is chaos with clues on structureless areas; excisional biopsy recommended.
Chaos, eccentric structureless pink areas, brown dots
Possibly milia but quality of image not good
Excisonal biopsy to exclude melanoma but may turn out to be a Seb K
First impression is chaos.
Excise with 2mm clinical margins.
Suspicious for a MM.
grey circles, red dots, dark dots, negative network – chaos -? melanoma
excision biopsy
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
Growing ,chaotic lesion with pink and brown some strucureless,areas
excise 2mm margin
exclude MM
Chaotic lesion ,undefined borders
Ugly Duckling
Plan: Excise with 2mm margin
I would review for interval change in 3 months given the age of the patient and the fact that this mole is similar to another further up on the photo.
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.
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
Asymmetrical ,Chaos, eccentric blackish clod and growing. Excise with 2 mm margins to exclude MM
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
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”.
It is not clear for me but if patient has this as a solo lesson and concerns then would do a shave biopsy .
– No sinister features. Reassure the patient. But if patient concerns I excise it after explaining of complication.
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
Looks asymmetrical/ chaotic, possibly some incomplete polygons, it has an eccentric structureless area, pink flush. I would excise as ? Melanoma ? Dysplastic naevi