Case discussion: How would you treat this patient? [8 February]

This week’s case discussion from Dr Terry Harvey features a 50-year-old female patient with a dark lesion on her right arm.

  • 50-year-old female patient
  • Dark lesion noted

What is your assessment of the clinical and dermoscopic images? What would you do next?

case discussion

Update

Here is the pathology result. What next?

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29 comments on “Case discussion: How would you treat this patient? [8 February]

  1. No mention how long present
    Dark brown pigment with lighter brown. Grey at periphery especially at 12, 2, 4 and 9pm. Peppering. I would biopsy this – punch if old lesion but if new remove whole lesion with 2mm margin.

  2. Given unknown duration and the presence of peripheral dots and circles, I would do a shave biopsy to exclude MMis.

  3. Asymmetrical lesion with thick reticular network and eccentric structureless area
    If new lesion,2 mm excision biopsy
    If old ,punch biopsy

  4. irregular pigment colour and multiple networks so regardless of history my

    management would be excision of lesion with 2mm margins

  5. 3 point check
    Asymmetry colour/structure
    central blotch with ?blue veil
    Err on the side of caution – small enough to do a shave biopsy to exclude melanoma

  6. Go for excision biopsy with adequate margin
    Primary intention treating the lesion as melanoma
    Once the biopsy report in hand look for adequate margin for the stage
    Then treat accordingly

  7. 50Y F
    Dark lesion noted
    Macro-asymmetric pigmented lesion
    Dermoscopic-asymmetry, irregular holes, peppering, globules. (Chaos plus >1 clues)
    Plan-excisional biopsy with ellipse and 3mm margin.

  8. There is some asymmetry of pigment in this lesion. If it is new, changing, or symptomatic, I would excised with 2 mm clinical margins. Otherwise, I would recheck in three months.

  9. PSL on sunexposed part of the body. Dermoscopic features are suspicious–chaos,few structureless areas,dots and clods etc. I would proceed to do a excision biopsy with 2mm margins

  10. Structureless dark centre with peripheral dotted pigments
    Likely to be MM
    I would shave biopsy or excise with 2 mm margin for histology
    I had a similar lesion that was reported as severely dysplastic naevus

  11. PSL showing asymmetry of structure and pigmentation, dark structureless blotch and some peripheral dark dots. Excise to rule out MM.

  12. Chaos in pattern with reticulated pattern and pattern of dots, no chaos in colour, Asymmetrical pigmentation, and some polygons in the center? Dysplastic naevus. Biopsy required with 2 mm margins

  13. I would do excisional biopsy . Asymmetrical flat lesion without any regular pattern . Malignant melanoma suspected .

  14. Asymmetrical lesion with thick reticular network ,peripheral dots pattern clods and eccentric structureless area MMI .. ????

    2 mm excision biopsy

  15. A tricky lesion. Is it new? Can we be sure either way? In my view, the clinical is suspicious – there is nothing else visible like this lesion. Dermoscopy for me is 1/3 and no specific features. At this age, if any doubt, it is tiny and easy to excision biopsy (I would use a wide diameter punch tool). MIS confirmed – wider excision follows.

  16. pigmented lesion with suspicious features. no place for punch Bx. need Ex Bx with 2 mm margins first, and then, if MIS-> do 5mm clear margin WLE.