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1800 867 1390Case discussion: How would you treat this patient? [7 February]
This week’s case discussion, submitted by Dr Terry Harvey, is a highly engaging five-part feature, with an update each day this week. A 35-year-old male patient with no personal or family history of skin cancer presents for his first skin check. Multiple moles are noted.
How do you manage these patients?
Update #1:
This image is of a lesion that was noted to be particularly suspicious. How do you evaluate this?
Update #2:
Here is the pathology report. What next?
Update #3:
Here is the wide local excision report. What next?
Update #4:
Here is the final report.
– Prof David Wilkinson
We encourage you to participate in the case discussions and submit your own clinical images and questions, so we can all learn together.
1300 856 695
+44 203 514 0688
1800 867 1390
There is a pink ulcerated lesion in the mid central of his back; which i would like to have a closer look at on dermoscopy
Dermoscopy of the moles to see his signature naevus pattern. Biopsy odd ones out.
Serial clinical photographs to look for changes of his moles
Advise to keep photographic evidence for regular follow up
Excision biopsy of lesion
Suspicious 2/3 (btw if would be helpful to know which of the many lesions this is)
Excision biopsy 2mm margins
faint polygons noted. shave it
Asymmetry shape and colour. ? Nodular melanoma or BCC
Excision biopsy with 2 mm margin
I would like to see the other moles onhis back on dermoscopy
if a mole looked suspicious, I would be excise for biopsy to exclude malignant changes.
Peripheral dots at 10 o’clock… I would excise this lesion
suspicious, 2/3, for excisional biopsy, serial image record
The dermoscopic image appears to be the lesion in the dead centre of the clinical photo. It appears to be an ‘ugly duckling’, looking more pink than the other lesions. On dermoscopy, there is a hint of regression in the 3 – 5 o’clock region of the lesion, and there is a fair amount of ‘pinkness’ throughout the lesion, though to be honest, it doesn’t outright scream out as a melanoma.
Just wondering… regarding the 3-5 o’clock area, is it still regression if it is not whiter than the surrounding skin. I’m not sure myself. Can anyone advise please. Cheers
Excision biopsy of suspicious lesion
One of those “uncertain” lesions. Some asymmetry, Slight flares of redness – When in doubt cut it out !– excision biopsy and review with patient with Annual skin check and mole mapping.