Case discussion: How would you treat this patient? [14 December]

This week’s case discussion features an interesting case from Dr Terry Harvey.

  • Female patient
  • Lesion on left shoulder

What do you make of the clinical and dermoscopic images presented? Benign or suspicious? If suspicious, how would you biopsy?

 

Update:

Here are the results. Thoughts? 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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20 comments on “Case discussion: How would you treat this patient? [14 December]

  1. Chaos present: more than one colour and more than one pattern.
    There is beautiful polygons. Also peripheral dot.
    Very likely a Melanoma. It needs excision with a 2 mm clear margin.

  2. Flat lentiginous with polygons. Very suspicious of melanoma insitu- lentiginous. Biopsy either with wide deep shave or excision with 2mm margins to get histology and if melanoma then its level and hence definitive margins required.

  3. Given the abnormal pigmentation networking, presence of polygonal features and annular lines, I’d actually excuse this lesion. It’s on an area that may have had considerable UV exposure and this patients skin looks to be that of a Fitzpatrick subtype 1-2.

  4. pigmented lesion with abnormal pigmentation , chaos, and polygons.
    I will treat this as a melanoma and do an excision
    In the picture it looks as though they are getting ready for a procedure.

  5. The presence of polygons and peripheral brown dots make this lesion suspicious.
    Shave biopsy would be my choice for the next step

  6. Good to see a consistent series of answers from colleagues here. A great pick up by Terry I think – I wonder how many doctors would not “see” this lesion? It is small and flat so a perfect biopsy option here is a “deep shave excision”. With diagnosis confirmed, can then move to complete excision with appropriate margins.