Case discussion: How would you treat this patient? [13 September]

This week’s case discussion, submitted by Dr David Stewart, features a 51-year-old male patient who presents for his routine skin check. This pigmented skin lesion is noted.

  • 51-year-old male
  • Pigmented lesion

What is your evaluation and what would you do next?

case discussion


Here is the pathology report. What is your structured approach to assessing lesions such as this?

case discussion

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6 comments on “Case discussion: How would you treat this patient? [13 September]

  1. Chaos present in structure, colour and border. Eccentric perifollicular pigmentation right upper. Radial streaming upper pole. Possible Lentigo Maligna. Excisonal biopsy with 2mm margin.

  2. Excisional biopsy with 2 mm margins.
    Three point checklist :
    asymmetry- present
    Atypical network – present
    Blue white structures – present.
    score 3/3
    ?Melanoma/ BCC

    1. Excision with 2 mm margin due to blue grey structure at 2 o’clock . Pigmented solar lentigo/ keratosis with possible transition to lentigo maligna

    1. # point check list is Zero but this white and brown globular lesion with bleeding blood vessels can not be considered as benign . It is a nevi that is becoming malignant . I am not on the side of actinic keratosis as the skin is intact around the lesion . We have to do a large and deep biopsy for diagnostic and after we will remove eventual malignant cells and refer if necessary . A follow up will be set up to control good or bad progress .