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

This week’s case discussion, submitted by Dr Mazharul Islam, features an 80-year-old male patient with a history of multiple keratinocytic cancers. This lesion was found on his right arm.

  • 80-year-old male patient
  • History of keratinocytic cancers

What do you make of the clinical and dermoscopic images? What would you do, if anything?

case discussion

Update

Here is the histopathology report. How would you treat?

case discussion

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

  1. Given significant past skin history, size of lesion ,irregular border ,irregular pigmentation and white whorls, suspect melanoma –excise 1cm margin .

  2. “Outstanding” lesion. Dermoscopic appearance suspicious of a melanoma. Excise with 2 mm clinical margins.

  3. ?Melanoma, asymmetrical, irregular border, heterogeneous pigmentation
    5mm punch biopsy of darkest region to plan excision considering irregular margin

  4. Chaotic PSL showing some line reticular at periphery and irregular size snd border. Excise to rule out MM.

  5. Sun damaged skin. Pigmented lesion with irregular border and asymmetry internally. Dark, pigmented area in the superior pole with no clear pigment pattern. Variation in pigment colour. Some areas if ? depigmentation.
    This is a suspicious , pigmented lesion and melanoma needs to excluded.
    Suggest excision biopsy with 2mm margins.

  6. My initial treatment would have been full excision with 2mm margin based on the asymmetry and loss of network to rule out a melanoma. This could probably have been achieved with a 6mm punch or small ellipse depending on the exact size.

  7. This case shows why we should always biopsy, before treatment. It is wrong to jump straight into excision here, and certainly to do so with large margins. This is a small, flat lesion – ideal for a deep shave biopsy excision. Or, certainly a 2mm excision biopsy. As Oli rightly says, it is so small that a large punch would also do the trick (removing the whole lesion).