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1800 867 1390Case 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?
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
Asymmetry colour and shape
Two kinds of network / atypical
Possible regression area
=suspicious
Excise with ellipse and 2mm margin
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
Biopsy
Colour variation, Regression, irregular border, Silver grey lines.
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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
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?
Agree with others. Asymmetrical thickened pigment ? Some regression. I don’t see blue/white. But would excise 2mm
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
suspicious features noted on dermoscopy-assymetry, atypical network, haziness in the margins. Excision biopsy with 2mm margin would be my approach.
Asymmetrical lesion with eccentric strutureless area and regression : excision biopsy
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.
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
Atypical dermoscopic island in a elongated lesion not resembling a nevus, needs excision to rule out SSM level 1
I would do an excision as it looks like a lentigo malignant with asymmetry of pigment , white blotches and radial lines
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
Melanoma : asymmetrical, color variations
Excise
Ugly duckling,area of digmentation and irreg network -excision
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.
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.
I will monitor the site for possible recurrence in 3 months, but no further action now.