Case 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?

Case discussion    Case discussion

Update:

Here is the pathology report. What next?

Case discussion

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15 comments on “Case discussion: How would you treat this patient? [2 November]

  1. 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

  2. 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. 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

  4. 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

  5. small pigmented lesion – asymmetrical in shape and colour
    Blue grey veil
    rec excision with 2mm margin

  6. 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.

  7. 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.

  8. Appers to be a form of Sclerosing nevus, reasses in 4 months as its flat and too small to see actual changes

  9. 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.

  10. 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

  11. 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