Case discussion: How would you treat this patient? [26 April]

In this week’s case discussion, we review another great case from Dr Terry Harvey featuring a 55-year-old female patient with a history of a melanoma in situ in 2010 who came in for her regular full body check.

  • 55-year-old female
  • History of melanoma in situ

What do you make of the clinical and dermoscopy images?

case discussion

Update

Pathology results below. What next?

We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.

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19 comments on “Case discussion: How would you treat this patient? [26 April]

  1. Agree with Alex could be amelanotic melanoma but also on magnification besides a few scattered nascent vessels there is the start of a reticulation pattern and irregular pigmentation. Consider early superficial spreading melanoma .Agree excision– 5mm margin.

  2. An asymmetric lesion with abnormal vessels and some pigment networks on 10′ and pigment network with some streaks and globules on 2′ there is an ovoid nest or globule on 1′??
    my provisional diagnosis based on the lesion and past history is to R/O Melanoma and the second is BCC
    MX: Excisional biopsy with 2mm margin and following up with the pathology for further intervention and management

  3. Eccentric hypopigmentation, assorted shapes of blood vessels, ?remnant of a reticular (disordered) network on the left
    Need to r/o amelanotic melanom
    Excision with at least 2 mm margin

  4. High risk with past h/o melanoma. distorted blood vessels on structureless background, few vessels with a halo and hairpin bend – ?melanoma/SCC. Will excise with 5mm margin.

  5. 2 pigmented reticular network at 3 & 9 o’clock and multiple polymorphus blood vessels some hair pin some glomerular blood vessels make the mixture of ? scc & melanoma , plus past history of melanoma and being on the leg which is the most common area for malignant melanoma in female patient makes her a strong candidate for excisional biopsy with2 mm clearance.

  6. Chaotic lesion. Asymmetry of structure and colour. Areas of milky red/pink shades. Very fine multiple grey dots over right periphery. Cluster of small brown clods at about 2 o’clock. Irregular areas of depigmentation. Polymorphous vessels – mix of irregular linear, coiled and hairpin vessels. Suspicious for amelanotic melanoma. DDx would be BCC (although some possible remnant of a reticular network at 9 o’clock would make it less likely). I would start with a 2mm margin excisional biopsy first then go from there. What a great pick up though, considering the very subtle clinical appearance.

  7. Chaotic PSL showing hairpin bleed vessels and some faint white lines can be appreciated. Excise to exclude AMM. BCC can be a differential.

  8. This lesion is suspicious. structureless area, chaotic vascular patterns, and pigmentation. Suspected amelanotic melanoma or BCC. I would perform wide excision biopsy with 2 mm margin ASAP.

  9. Irregular pinkish lesion with whitish areas and dominent feature I think are the arborising and serpentine blood vessels with some
    Likely BCC not withstanding the p/h of melanoma
    Would do several punch biopsies to assess first.

  10. Pigment + odd vessels +history= High probability of amelanotic melanoma
    Biopsy with 2 mm margin if possible, otherwise deep shave and close as best

  11. Interesting case, and responses. For me, the dermoscopy was a “blink” BCC – the sharp arborising vessels are almost diagnostic. However, the other vessel morphology is worrisome. A definite punch biopsy to get a diagnosis.