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1800 867 1390Case discussion: How would you treat this patient? [1 February]
This week’s case discussion from Dr Aung Lynn features a 72-year-old female patient with no complaints, presenting for a skin check. She is unaware of the lesion on her arm.
- 72-year-old female patient
- Unaware of lesion on arm
What is your evaluation? What would you do next?
Update:
Here is the pathology result. What next?
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1300 856 695
+44 203 514 0688
1800 867 1390
Solar lentigo vs Nevus
Asymmetrical in shape and colour
Atypical network
No regression areas
= suspicious needs excision with 2mm border
Looks like a melanoma in-situ
Also is an ‘ugly duckling’
Not clear dx
Needs excisional biopsy
Didn’t mean to reply to your comment
Sorry
Tricky one – could be a flat seb k or a lentigo. But given the darker area (Chaos with thick lines reticular but it’s not severe) I would probably go for excision biopsy. It’s small enough for an easy full excision. Alternative is single lesion monitoring.
Melanoma in situ query
Solar lentigo
Moth eaten sharply demarcated border
No blue or black
No thick lines
No eccentric structureless area
No abnormal vessels
Chaos and thick lines
Needs excisional biopys with 2mm margin
Could be benign but melanoma needs exclusion
Benign skin lesion ( Naevus)
Review 3 months
Lentils maligna?
Moth eaten border. Looks like lentigo to me. Some asymmetry. Depending on history. If rapidly growing or ugly duckling would change my opinion but for now I’d leave it.
interesting that people can be so unaware of what’s on their skin;
stand out lesion/ugly duckling, large brown macule, several shades of brown
dermoscopy – chaotic; no network; several shades of brown; pattern of brown circles but with asymmetric pigmentation of these; one circle within a circle; some grey at 3 o’clock
I would shave as suspicious for lentigo maligna
Certain concerns : irregular border, an asymmetry of pigment distribution ,but on magnification reticulation not as well defined as one expects in a melanoma in situ and absence of grey whorls/circles.Therefore due to uncertainty melanoma in situ/solar lentigo excise with 5mm clearance
Suspicious lesion
Scores 2
Excisional biopsy with 2 mm border
When biopsy is back then decide on the next step
Likely melanoma in situ
approx. 8 mm lesion; chaos present; variable pigmentation; dark blotches of brown at several peripheral edges of lesion
Imp: r/o melanoma, remove with 2 mm margins
History/demographics 72y F.
Macro-ugly duckling
Dermoscopic-Asymetry, Atypical network-irregular holes and thick lines, white areas-3 and 4 o’clock, peripheral clods?
Plan. Excisional biopsy with minimum 3mm margins.
PSL in an old lady, showing some dark blotches and chaotic structure. I would be wary and excise it to rule out MM.
I would perform excisional biopsy with 3 mm margins
Dermoscopy 3 point checklist gives it a score of 2 which is suspicious.
asymmetrical in color and structure with tan like structureless areas and atypical pigment.
Because it is suspicious, I would excise it.
Would take excisional biopsy.
Could be a solar lentigo or flat seb K but given the asymmetry and atypical pigment network -2/3, needs excision with 2 mm margin.
Solar lentigo with differential of lentigo maligna.
Could be easily excised. Or if patient would prefer monitoring x1 for any change and action
WLE 10 mm margin
Histopath says “complete excision” but no clearance measurements
We would need at least another 5mm margin overall (?).
I would appreciate comments.
Re-excision ( wide local excision) with > 5mm clear margin