Case discussion: How would you treat this patient? [4 October]

This week’s case discussion, submitted by Dr Terry Harvey, features a 65-year-old man who came for a routine skin check with no specific concerns or history of skin cancer.

  • 65-year-old male
  • No history of skin cancer

What do you make of these images?

case discussion


Here is the pathology result. 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? [4 October]

  1. Looks like pigmented straight lines snd rhombic structures so my main differential diagnosis would be lentiginous melanoma.

  2. This Flat Lesion is suspicious of melanoma hence excisional biopsy with 2 mm peripheral margin and deep to subcutaneous fat

  3. Polygons / angulated lines with grey clods points to extra facial LM. Excuse with 2 mm margin to exclude that.

  4. Serpentine vessel for pigmented lesions

    Ddx – pigmented BCC , MSC

    . I will go with full excision for 3 mm margin, depth to mid fat layer

  5. Dotted vessels and a pattern of grey dots and structureless pink is supsicious for melanoma (in situ?)
    Would excise with 2 mm

  6. Atypical structure and asymmetric lesion
    amelonocytic melanoma is also possible

    Will do excision with margin/shave biopsy atleast

  7. Pigmented polygons , Grey peppering, structureless pink, dotted vessels . Concerning for MM . Excisional biopsy

  8. Pigmented skin lesion
    Irregular margins varying shades if pigment
    ? seborrhoeic Keratosis
    ? Melanoma
    ? SCC

  9. Melanoma – chaos pattern and colours, structurless areas, dot vessels, excision biopsy with 2mm margin and await histology report for further wide excision +/- SNL biopsy if indicated

  10. Dermoscopic findings – Chaotic structureless patch on the back with variable pigmentation.
    Brown and red dots noted with polymorphous vessels and atypical pigment network.
    Diagnosis – ? SSMM
    Mx – refer 2WW.

  11. Any particularity . Lesion no suspicious . i did not see well if the skin around the lesion is safe . it is looking like a keratosis skin . He should need traitement for that .Encourage him to continue doing regularly check and to protect his skin against agressions .

  12. Another great pick up from Terry. We see so many patients like this in Qld and it is so difficult to review all their skin carefully when there is so much solar damage. So easy to pass over this one if not looking very carefully, slowly, and critically……