Case discussion: How would you treat this patient? [28 June]

This week’s case discussion, submitted by Dr Terry Harvey, features a 30-year-old female presenting for her first skin check, with no specific complaints. Please review the images and provide your thoughts. The lesion of interest is marked with a back pen.

  • 30-year old patient
  • First skin cancer check

What would you do, if anything?

case discussion

Update

Here are the results. What are your thoughts? What are the next steps?

case discussion

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18 comments on “Case discussion: How would you treat this patient? [28 June]

  1. Asymmetric lesion with polygons,eccentric structureless area
    For excision biopsy with 2 mm margins

  2. Multiple Circles of brownish pigmentation at lower leg. Not sure of that. It could be merely a nevus. I am not convinced those are polygons. I will wait for the result.

  3. The lesion of the 30th year ol lady is symetric (circular ) , network cells are at leat similar . There is any sign of cicatrisation or abnormal blood vessels , This lesion is benign , live it .Any action needed .

  4. Possible melanoma – superficial spreading?
    Will do or refer for excisional biopsy with 2mm margin

  5. Macroscopically it catches your eye. 12 oclock granular pattern and broken reticular network. Loss of structure ? regression at 6 oclock and 4 oclock . I would like to biopsy, 2 mm margin , but not compelling, could share decision with the patient to wait 3 months and look again. Melanocytic lesion.

  6. As there is couple of possibilities such as dysplastic naevus/junctional naevus and ?melanoma, I will consider first shave biopsy first.

  7. strange dermoscopy; I’m thinking this was dermoscopically quite different to the patient’s other naevi/ugly duckling; pattern of circles of differing sizes and shapes, with variable pigmentation around the circles and patchy granular pigmentation distributed irregularly through the lesion; this isn’t a lentigo and no features to support diagnosis of seb k; I’m not sure of the size of the lesion, if possible I would excise with a 2mm margin, otherwise a shave excision

  8. tan colored structureless area at the 6 o clock position in otherwise normal looking background skin that is free of sundamage.
    punch biopsy?

  9. Another great pick up by Terry! I think the only guidance I can give here is 1) it is an ugly duckling, a lonely lesion, 2) dermoscopy is not diagnostic (in my view) so it gets a biopsy. It is small so I would use a large punch to do excision biopsy. Great work Terry

    1. Ugly duckling indeed.

      I think ugly duckling is used as a clinical term a lot and rightfully so – but for me this lesion had the dermatoscopic ‘ugly duckling’ sign. This women had many identical flat junctional naevi with beautiful typical thin brown reticular lines/pigment network.

      This one look nothing like the others.