Case discussion: How would you treat this patient? [19 April]

This week’s case discussion from Dr Terry Harvey features a 20-year-old male presenting for his first skin check with no lesions of concern.

  • 20-year-old male
  • First skin check

Please review the clinical and dermoscopy images. Please provide an evaluation and what would you do next?

case discussion


Here is the pathology. Thoughts? Next steps?

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22 comments on “Case discussion: How would you treat this patient? [19 April]

  1. Asymmetric blotch. Could be short term monitored as early mis or biopsy excision carefully marking area of concern.

  2. The areas of concern are those which are more deeply pigmented at 11 and 12 o’clock.Variable pigmentation with reticulation rhomboid shapes, a few early whorls ,growing disordered pigmentation inferiorly. The concern would be for melanoma in situ .Excision biopsy 5mm margin.

    1. Hi Dr Andrews, the pathology result will be published on Wednesday. 🙂 Thank you, Abbie | HealthCert

  3. Suspicious melanotic mole for complete excision with 2mm margin and await histology.
    Do full skin check, history including FHx, sun smart education and follow up every 6 months due to fair skin.

  4. Multi colored asymmetric lesion with pigment network, specially in 10′ and 11′
    provisional dx: Lentigo simplex, dysplastic nevus? R/O SSM
    Plan: shave biopsy of the whole lesion with 2mm border and further action according to the pathology result

  5. unique looking, lonely lesion
    chaotic pattern with pigment network and melanin at different levels in the epidermis,
    I would be concerned.

  6. Any history of concern does he has. I can see some colour variations snd a dark blotch at the left side and some dark dots/ clods on the right side. Excise to rule out any malignancy. It might come dysplastic nevus.

  7. Is the X marking the correct lesion? The dermoscopy image seems to correlate better with the larger darker lesion at left lower mid back.

    If not he seems to have three or four similar naevi on his back – circular, light brown, with one or two darker areas,
    which might make one more relaxed. That is, not an ugly duckling.

    However looking at the clearly different part of the lesion at 10o’clock. Taken on its own, it is assymetrical in shape, has atypical network, and grey regressive area at 7o’clock.

    So a suspicious lesion perhaps melanoma arising in a pre-existing benign naevus.

    Excision biopsy with 2mm margin will provide the answer. And may also provide some guidance regarding his other naevi.

    1. Hi Andrew, the X marked lesion is not the lesion featured in the dermoscopy image. You are correct in saying that the dermoscopy image correlates with the darker lesion at the left lower mid back.
      Thank you, Abbie | HealthCert

    2. Andrew – the X is a standardised reference location marker I use when photographing the back of all my patients. It isn’t related to the dermatoscopy image – which is of the lesion on the left back more inferiorly.

  8. Assymetry of pigmentation with periferal globules on 11 h, with assymetry of structure. I suggest excisional biopsy.

  9. case discussion 19 April:pigmented skin lesion central upper back
    polygonal & globular structure is the cause of concern for melanoma, excisional diagnostic biopsy is suggested.


  10. chaotic lesion, atypical network at 1:00 and 11:30; ?small islands of regression scattered t/o lesion
    Plan: bx or excise whole lesion with 2 mm surgical margins

  11. Another great case from Terry – thanks. A stand out “lonely” lesion demands dermoscopy review – then (for me) a 2/3 on 3 point (asymmetrical and more than 1 network). Then, needs 2mm excision biopsy. Final stage 2 excision with 5-10mm margins.