Case discussion: How would you treat this patient? [22 November]

This week’s case discussion, submitted by Dr Terry Harvey, features a 62-year-old lady with a history of two BCCs who presented for a routine check.

This lesion on the right clavicle was completely new and not present on imaging from 12 months earlier. What would you do?

  • 62-year-old female
  • History of BCCs
  • New lesion on clavicle

– Prof David Wilkinson


Here is the histology:

case discussion

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14 comments on “Case discussion: How would you treat this patient? [22 November]

  1. A new pigmented lesion in this age group is of concern. No unequivocal clues to a benign lesion like a seborrhoeic keratosis. I would recommend excision.

  2. Would prefer a larger view of this though what I can see I think looks benign

    However, as it is new, it should have an excisional biopsy done

  3. Taking into account the age and it’s a new of 12 months duration. Dermatoscopically shows irregular varied globular sizes and patterns. its preferable to excise or being watchful for 2-3 months of the lesion again. If she cant commit to come, I would excise to rule out any malignancy. it can be merely a benign nevi.

  4. It’s new, she’s above 60, p/h skin cancers, pigmented, asymmetric melanin deposits although no clear network nor regressive features and its a small lesion <6m but we now know that small does not mean non-invasive when it comes to melanoma.
    But change trumps everything so I would excise with a 2mm margin.

  5. globular nevi with peripheral clods as noted in a 60 + year old needs shave excision as its a SSM until proven otherwise

  6. new pigmented skin lesion in older patient. no clearly benign diagnosis. for excision biopsy with 2mm margins

  7. Image too small to comment on dermoscopy , however new pigmented lesion in pt > 50yo with history solar damage/malignancy warrants excisional biopsy, 2-5mm margins.

  8. Looks like we all agree to excise a new PSL at this age – and I agree! And, as Terry’s case shows, not all new lesions at this age are melanoma. Still right to excise!!

  9. New small melanocytic Nevus in elderly is not normal. The lesion is melanoma and needs to be managed as melanoma.