Case 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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27 comments on “Case discussion: How would you treat this patient? [1 February]

  1. Asymmetrical in shape and colour
    Atypical network
    No regression areas
    = suspicious needs excision with 2mm border
    Looks like a melanoma in-situ

  2. 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.

  3. Solar lentigo
    Moth eaten sharply demarcated border
    No blue or black
    No thick lines
    No eccentric structureless area
    No abnormal vessels

  4. 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.

  5. 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

  6. 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

  7. Suspicious lesion
    Scores 2
    Excisional biopsy with 2 mm border
    When biopsy is back then decide on the next step
    Likely melanoma in situ

  8. 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

  9. 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.

  10. PSL in an old lady, showing some dark blotches and chaotic structure. I would be wary and excise it to rule out MM.

  11. 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.

  12. 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.

  13. Solar lentigo with differential of lentigo maligna.
    Could be easily excised. Or if patient would prefer monitoring x1 for any change and action

  14. Histopath says “complete excision” but no clearance measurements
    We would need at least another 5mm margin overall (?).
    I would appreciate comments.