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1800 867 1390Case 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?
Update
Here is the pathology result. What next?
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1300 856 695
+44 203 514 0688
1800 867 1390
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.
Given unknown duration and the presence of peripheral dots and circles, I would do a shave biopsy to exclude MMis.
Asymmetrical lesion with thick reticular network and eccentric structureless area
If new lesion,2 mm excision biopsy
If old ,punch biopsy
3 point checklist=1/3 for asymmetry.
Not for excision biopsy.
Will advise to monitor
irregular pigment colour and multiple networks so regardless of history my
management would be excision of lesion with 2mm margins
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
Is it a new lesion
Asymmetrical wih irregular pigment-will excise lesion with 2 mm margin
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
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.
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.
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
Suspicious pigmented lesions
Score – 3
Excisional biopsy 2 mm margin
Suspicious for melanoma
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
PSL showing asymmetry of structure and pigmentation, dark structureless blotch and some peripheral dark dots. Excise to rule out MM.
Excision biopsy even though it looks benign
Dermoscope score 0/3
compound melanocytic nevus, leave alone. not evident enough to warrant excision. reasses in 4 months
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
I would do excisional biopsy . Asymmetrical flat lesion without any regular pattern . Malignant melanoma suspected .
Asymmetrical lesion with thick reticular network ,peripheral dots pattern clods and eccentric structureless area MMI .. ????
2 mm excision biopsy
structureless, grey dots and clods, periferal lines
MIS
Potentially a new lesion in a 50-y-o.
I’ll do excisional biopsy with 2 mm margins.
Looks like dysplastic naevus, I would do excision biopsy.
Look like superficial spreading melanoma Can do excisional biopsy with 2 mm margin
Or excise with 5 mm safety margin
Chaos and peripheral dots/clods
For excisional biopsy with 2mm margin
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.
Assymetrical
Border is ragged at periphery
Colour, 2 at least – irregular pigment.
Biopsy
Re excise scar with 2mm margin
wide re excision with 5m margins from scar
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.