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1800 867 1390Case 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?
Update
Here is the pathology result. What next?
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1300 856 695
+44 203 514 0688
1800 867 1390
suspect features for a M. other dds diagnosis relevant only upon excision with 2mm margins
Looks like pigmented straight lines snd rhombic structures so my main differential diagnosis would be lentiginous melanoma.
Look like melanoma – irregular shape and network.
border not sharp
area of regression
grey polygons, shave to exclude MIS
This Flat Lesion is suspicious of melanoma hence excisional biopsy with 2 mm peripheral margin and deep to subcutaneous fat
Asymmetry shape and colour, blue grey veil
Shave buopsy to exclude Melanoma in situ
Polygons / angulated lines with grey clods points to extra facial LM. Excuse with 2 mm margin to exclude that.
Serpentine vessel for pigmented lesions
Ddx – pigmented BCC , MSC
. I will go with full excision for 3 mm margin, depth to mid fat layer
Dotted vessels and a pattern of grey dots and structureless pink is supsicious for melanoma (in situ?)
Would excise with 2 mm
blue gray globules
bcc
Atypical structure and asymmetric lesion
?SCC
amelonocytic melanoma is also possible
Will do excision with margin/shave biopsy atleast
Pigmented polygons , Grey peppering, structureless pink, dotted vessels . Concerning for MM . Excisional biopsy
chaotic, asymmetric lesion. needs excision
Pigmented skin lesion
Irregular margins varying shades if pigment
? seborrhoeic Keratosis
? Melanoma
? SCC
NP lesion
Arborising vessels seen
Poss BCC
3 mm punch Biopsy
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
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.
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 .
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……