Case discussion: How would you treat this patient? [24 January]

This week’s case discussion from Dr Bronwyn Edmunds features a 77-year-old woman who had an acral in situ melanoma excised from her foot by a general surgeon, and then a plastic surgeon for the wide local excision. During a skin check three months later, the following images were taken.

case discussion

Dermoscopy 20x magnification
Dermoscopy 30x magnification

 

What do you see, and what would you do?

Update

Excision biopsy of the suspicious pigmented skin lesion was done and another melanoma in situ was diagnosed. How did this happen? What would you do next?

histopathology

– Prof David Wilkinson

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8 comments on “Case discussion: How would you treat this patient? [24 January]

  1. Brownish bridge pattern pigmentation can be seen. Given the history and the age I think this should be treated with great caution. Excision biopsy to exclude recurrence.

  2. Difficult to see the scar and orientation of the new lesion with the scar
    I would biopsy this lesion to rule out recurrence

  3. From what I can see, it appears there is furrow pigmentation pattern which would make it highly suspicious for MM – so punch/shave – anything to get a tissue diagnosis!

  4. Melanoma cannot form 3 months after an excision, appears to be a benign nevus that was not looked into initially. Recurrence takes about 5-10 years to happen usually. Appears to have fibrillary and lattice patterns

  5. A great case from Bronwyn – thank you for contributing. It looks like this ‘second’ melanoma was missed / ignored when the ‘first’ one was treated……..Unfortunately, I see this kind of error / omission quite often in my clinic……so, difficult as it sometime is – try to keep “fresh eyes” on the patient each time you see her / him. By that I mean, treating every skin check as the patient’s first one