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1800 867 1390Case discussion: How would you treat this patient? [2 November]
In another interesting case from Dr Terry Harvey, we feature a male patient who presented for a skin check.
Please review the clinical and dermoscopic images below. What is your evaluation and what would you do next?
Update:
Here is the pathology report. What next?
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
3 mm pigmented lesion with overall reticular pattern, asymmetrical in color and structure
Clues to malignancy include; structureless brown/grey areas composing around 40% of the lesion, atypical network, peripheral black dots, polygonal arrangement of pigment.
Excise with 2 mm margins, differential a superficial spreading melanoma until proven otherwise
Excision with 2 mm margins to get a diagnosis.
Suspicious lesion on dermoscopy
I would say this shows chaos and some grey structures, so should be excised with at least 2mm margins.
Also, at 0600 and 0300 in the photo, there seem to be LPLKs, indicating immune attack.
3 point check
Atypical retic network
Asymmetry colour structure
Blue grey veil
3/3 : highly suspicious of melanoma
Excision biopsy with 2 mm margin or saucerisation biopsy
Chaos. Early polygons, regression. Sus for MM. Excise 2mm margins.
Sun damaged skin,
Thickened network, asymmetry/chaos, some grey haze, suspicious for MIS
Would excise w/ 2mm margin, wider excision if proven to be melanoma
Would also need to check lesion further up to the right
small pigmented lesion – asymmetrical in shape and colour
Blue grey veil
rec excision with 2mm margin
Excision central pigmented lesion with 2 mm margin
to exclude from melanoma
I am not sure if this can be called a reticular patterns. I prefer to call it chaotic small pigmented lesion with ?polygon
I would biopsy this lesion with 2 mm margin as I cannot name it.
BCC on SebK
Chaos of border, structure and colour.
Clues of polygon-like structures and black clods at 11 o’clock, eccentric structure inferiority, grey colours.
Suspicious for melanoma. Excision biopsy with 2 mm margins recommended.
Appers to be a form of Sclerosing nevus, reasses in 4 months as its flat and too small to see actual changes
Asymmetry of colour and pattern ie Chaos. Grey colour and polygonal lines as clues to malignancy on a background of excisional biopsy with 2mm margins. Expect lentiginous melanoma.
3mm flat pigmented lesion, atypical network , multiple colours , grey dots,
Rhomboid stucture 10-11 o’clock , regression
excision biopsy with 2 mm margin,
D/D MIS, lentiginous melanoma
A good pick up, I would suggest! Easy to see, and ignore. Dermoscopy raises suspicions and so a large punch biopsy (including the whole lesion) is an easy way to go