Case discussion: How would you treat this patient? [16 November]

In this week’s case discussion, we feature an interesting case from Dr Tim Aung:

  • 45 year-old female
  • Lesion noted during a skin check

Please review the clinical and dermoscopic images below. What would you do, and why?

Case discussion     Case discussion

Update:

Here is the pathology report. What next?

Case discussion

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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20 comments on “Case discussion: How would you treat this patient? [16 November]

  1. Asymmetry colour and shape
    Two kinds of network / atypical
    Possible regression area
    =suspicious
    Excise with ellipse and 2mm margin

  2. Location would have been helpful
    3 point check
    Asymmetry colour/structure
    Blue grey veil
    Atypical reticular network
    Highly suspicious of melanoma
    Management: 2 mm clinical clearance excision

    1. Hello.

      Nice to hear from you. Are you from India- Tamil?

      I am looking for a collegial working group for dermatology learning and sharing experiences.

      You can reply to my email. Thanks

  3. marked asymmetry of colour and pattern, several shades of brown, some pink too although I can’t make out any vessels, thickened network, peripheral structureless areas; this one needs histopathology, excise with 2mm margins

  4. I’m wondering if the upper area, dark area is a Seb K, however the lower area, although i can’t see it clearly, is it a regressed area or continuation of the Seb K?

  5. Asymmetry, eccentric structureless area; thick reticular lines. There are parallel lines but as anatomical area is not revealed, I don’t know how important they are. The darker side of the lesion has features of a seb K, but I would do an excision biopsy with 2 mm margin

  6. suspicious features noted on dermoscopy-assymetry, atypical network, haziness in the margins. Excision biopsy with 2mm margin would be my approach.

  7. Chaotic PSL showing different colours and structure. I can’t see any specific pattern just thick colour??? Can’t appreciate any vessels though. I guess I should take a biopsy 1mm for histology to rule out any suspicious lesions. It might turn out SK. The lady is 45 and as said it was found accidentally. So best to be on the safe side.

  8. certainly variation in colour with reticulation / border not definitely classically asymmetrical/ but size of lesion ?9mm a concern —initial 1st glance impression perhaps dysplastic naevus, but magnification suggestive of melanoma—excision with 5mm margin

  9. I would do an excision as it looks like a lentigo malignant with asymmetry of pigment , white blotches and radial lines

  10. Reticular pattern. Rhomboid structures. Assymetrical pigmented lesion. I would biopsy it making sure I get either whole lesion or a punch that captures a piece of both halves. Lesion a bit big at about 15mm so to remove all and turns out benign may be hard for patient to accept. A 4-5 mm punch in the center sampling both halves should suffice. Concern is melanoma

  11. 2 key learnings from this case I suggest: 1) this is a suspicious pigmented skin lesion and as such needs a 2,, excision biopsy (not 5mm), 2) excision biopsy shows it to be a “low grade dysplastic nevus”. This is benign and needs no further treatment. Thanks everyone.

  12. Let me add further key-points.
    – Not every SPL is melanoma. However, if suspicious (not confident enough for benign)> CUT (as David usually indicated).
    – No need to do 5mm or 10mm initially without establishment of MM and Breslow thickness. Thus 2mm margin excision initially, and then go from there (Report).

    Location: over the back of lady.