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1800 867 1390Case 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?
– Prof David Wilkinson
Update
Here is the pathology result. What next?
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1300 856 695
+44 203 514 0688
1800 867 1390
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
Looks like a melanoma insitu
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
Biopsy
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.
Ugly duckling
Has to be a melanoma
Excision biopsy 2mm margins
A biopsy is needed.
Wait for the result and possible advise from Dermatologist
looks like melanoma, i will do excision biopsy with 2mm margin
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.
sws
asymmetry
blue whitich veil
asymmterical globules
biopsy
melanoma
A pigmented lesion with asymmetrical colour and structure. I will managed it as suspected melanoma and do a excisional biopsy
Working diagnosis is melanoma and
Narrow margin excision biopsy is preferred
MM till proven otherwise! Needs an excisional biopsy with 2mm margins.
Melanoma for wide excision asap
Looks like a BCC – recommend biopsy
not clear to comment as its non contact dermoscopy . shave can be done
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
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
Excision biopsy w atleast 3mm margin
Agree with the differentials. MM until proven otherwise – excise with 2mm margins
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
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.
the histopathology shows MIS with extension to the lateral margin .
He needs Wide local excision with 5mm margin .