Case discussion: How would you treat this patient? [18 January]

This week’s case discussion, submitted by Dr Terry Harvey, features a 63-year-old female patient with no previous skin cancers and no specific concerns, presenting for a full skin check.

  • 63-year-old female
  • No specific concerns

What do you make of the clinical and dermoscopic images? What would you do next – if anything?

Update:

Here are the results. What next?

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19 comments on “Case discussion: How would you treat this patient? [18 January]

  1. chaos present; ?grey at 2:00 o’clock, ?eccentric structureless area(s); thick lines reticular
    Imp: ?melanoma
    Plan: remove with 2 mm margins

  2. there is chaos in colour,but i do not see any clue
    i would sugest check in 2 months again and then punch biopsy can be done in that area

  3. 3 point check: atypical reticular network; asymmetry colour and structure
    Suspicious
    Needs biopsy: small macule therefore shave excision biopsy

  4. melanoma in situ – I would perform an excision with a 3mm margin to obtain histological confirmation prior to wide local excision with appropriate margins

  5. Atypical reticular network pattern. DOtted vessels (but present off lesion too so likely not important). Minimal gray present too. I would biopsy lesion with 2mm margins.

  6. in the physical image, I am not sure which one in question, maybe due to the internet but the second image shows quite clearly a chaotic structure of thick line reticular with central dot vessels in most the thick lines. I would excise and send for HP to exclude malignancy; MM.

  7. after reviewing 2 given pictures- it has been founded that- asymmetry shape and colour with atypical pigment network
    Regarding to 3 point check list- this one has score 2 , melanocyytic naevi.
    according to the guide line we should do – Excision because of suspicious.

  8. chaos in pattern and clues (thick lines reticular and polymorphous vessels )
    I would do excision biopsy either punch with 2mm margin or shave biopsy

  9. Ugly duckling
    Asymmetrical colour and shape
    Atypical network
    Possible regression areas
    Suspicious for melanoma
    Excision biopsy 2mm borders

    BTW any chance of having an automated reply when the histology goes up each week so one doesn’t have to remember and find one’s way back to the relevant case post?

  10. Chaos is present. Atypical pigment network, polymorphic vessels, eccentric structureless areas, peripheral gray dots. Melanoma. Excision with 2 mm margins.

  11. Clinically a leg lesion in a woman suspicious of melanoma. Dermoscopy:
    – From 3-point check: Asymmetry, atypical network
    – Asymmetry in structure (Chaos); then thick reticular lines, radial lines, eccentric structureless areas(Clues).
    So, suspicious of melanoma (?superficial spreading). Excision biopsy with 2mm clearance is the next step of management. Thank you.

  12. Great pick up clinically, I thought, and easy to miss. Dermoscopy helps a lot – at least 2 on the 3 point checklist means biopsy is needed. I reckon I would do a shave excision biopsy as it is small and flat. MIS then needs full formal excision as we all know with 5-10mm margins