Case discussion: How would you treat this patient? [10 January]

This week’s case discussion, submitted by Dr Puneet Goyal, features a 71-year-old male patient with a previous history of non-melanoma skin cancer. This lesion is noted during his skin check and he is unsure if it’s new.

  • 71-year-old male
  • History of NMSC
  • Lesion noted

Please review the clinical and dermoscopic photos. What would you do next, and what is your working diagnosis?

case discussion case discussion

– Prof David Wilkinson

Update

Here is the pathology result. What next?

case discussion

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23 comments on “Case discussion: How would you treat this patient? [10 January]

  1. He needs a biopsy . Due to size, asymmetry, multiple colors, structureless pink I would consider punch biopsies but I would seek out dermatology advice as this is too large for excisional biopsy and I am not sure where the best location for a punch would be . Confocal might be useful if one had that machine and skill . Concerning for MM

  2. Solitary lesion in that region.
    Asymmetrical, unable to say if there is irregular thick reticular lines.

    Blue grey areas noticeable.

    Suspicious, excise the lesion with 5 mm margin.
    ? BCC vs Melanoma

  3. Wide differential. As it is small excision biopsy is useful, with option for wider excision if needed. Working diagnosis – Pigmented BCC, Pigmented Seb K, Melanoma.

  4. It’s one stand alone dark skin lesion with varied colours. I am not sure if there is any structure but dark black blotch with an area of reddish at one part. No vessels seen. Some dark clods? And grayish blue structureless area. The picture is not in focus to comment precisely. My DD; could be Seb K, MM always in mind to be ruled out.
    Take a multiple biopsies perhaps from the most dark areas.

  5. A pigmented lesion with asymmetrical colour and structure. I will managed it as suspected melanoma and do a excisional biopsy

  6. asymmetry, multiple colors, irregular pigmentation ,structureless pink a possible melanoma or MIS
    Excision biopsy –simple z- plasty will facilitate excision with 4mm margin and closure

  7. Suspicious lesion [ asymmetry of colour and structure , bluish veil , clods , possible radial streaming in parts ]
    I would do excisional biopsy with 2 mm margin
    Diagnosis most likely : melanoma

  8. The case has for the 3 check point list of 2 . Asymetric lesion and abnormal colors . And there is no network. I will do a deep biopsie and wait feom anapath result

  9. Hello all, With any suspicious pigmented skin lesion, i would urge colleagues to always do an excision biopsy (remove the whole lesion). This can be done as a shave if the lesion is small and flat, so long as it removes the whole lesion. Do NOT do partial (punch) biopsies as you leave parts of the lesion on the patient, and you may get an inaccurate report from the pathologist. Clinically here, melanoma has to excluded, as the primary differential diagnosis. With MIS confirmed, next step is a wide local excision – 1cm margins.