Case discussion: How would you treat this patient? [22 March]

This week’s case discussion from Dr Terry Harvey features a 70-year-old lady attending her routine 12-monthly skin check. She had a history of many BCCs but no previous melanoma. She had no specific lesions of concern.

  • 70-year-old female
  • History of many BCCs
  • Patient had no specific concerns

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

case discussion

Update

Here is the pathology report. What next?

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15 comments on “Case discussion: How would you treat this patient? [22 March]

  1. Asymmetrical lesion with pigmented globules. I couldn’t see any reticular pattern. It looks like a pigmented BCC, however; the pigmentation on right side of lesion looks quite big for Pigmented BCC so I will be worried about melanoma as well or mixed of both. I’ll biopsy the whole lesion with 2mm margins.

  2. In the days before doing the course lesions like this might have passed me by, certainly without the benefit skilled use of a dermatoscope.

    It is an ugly duckling.
    I can’t see a network but irregular in shape and colour
    The is a grey ‘veil’ over the right right side pigmented area.
    So a suspicious lesion excise with 2mm margins.

    Maybe an aytpical pigmented BCC but melanoma more likely I think

  3. Yes once again good pick up –not classic reticulation pattern for MM but asymmetrical and disordered variable pigmentation, and with history of BCC needs an excision biopsy 5mm

  4. Chaotic but can’t see any network of MM. I can appreciate dark blue clods and some faint haemorrhage which would make BCC. But it must be off to rule any sinister.

  5. Lesion has three zones. Two pigmented sections with irregular margins, chaos, clods and a veil (on the right); and, a zone of pale erythematous change with scattered pigment. Suspicion of MM has to be high. So excision with 2mm margin for diagnosis and planning the definitive excision (or referral for sentinel nodes as per melanoma clinic if it’s not superficial). The main hazard I can see is in picking the true margin. The lesion extends from top to bottom of the image and off to the right somewhere. It would also be reasonable to warn the histopathologist of the multiple zones when sending the sample.

  6. irregular shape and multiple pigmented lesion on the back
    dermatoscopically multiple pigmented dark brown black clads , multiple black dots ,blue veil- melanoma
    needs excisional biopsy with 2 mm margins

  7. Evaluate for Gorlin Goltz syndrome, teach precaution for preventing /reduction of new BCC.

    Provide field therapy for existing BCC.

  8. x2 lesions .Left lateral irreg outline with irreg networks and wide ecxision ??MM . Right lesion ?blue neavus

  9. Chaotic lesion with clues of structureless area, thick reticular lines and blue/grey veil.
    It’s a MMIS or melanoma and needs excision biopsy.

  10. Melanoma lesion: definitive excision to total margin 10mm and check with histology. On-going melanoma checks.