Case discussion: How would you treat this patient? [21 March]

This week’s case discussion, submitted by Dr David Stewart, features a 60-year-old male with a longstanding pigmented lesion on his temple. Change is noted on serial images.

What is your assessment? How do you evaluate lesions like this? What would you do next?

case discussion
2021
2022
Macro

Update

Here is the pathology.

– Prof David Wilkinson

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23 comments on “Case discussion: How would you treat this patient? [21 March]

  1. This pigmented lesion is asymetric no specific structure , has extended on the left part , more defined superior margin in favour of LM , can not exclude melanoma , must be excised for histopathological confirmation

  2. The lesion is asymmetrical in Colour and shape, Has a tinge of blue/white area with disturbed networking.
    It would need biopsy to investigate Melanoma.

  3. Magnified view intradermal dermatosis/seb keratosis, but variation in pigment and asymmetry suggestive of MIS needs excision biopsy.

  4. from photo 2011 there are rhomboids now I think there is obliteration of hair follicles
    melanoma for excision with safety margin

  5. There is a noticeable change in size and in structure.
    I would recommend excision or biopsy.

  6. Reticulated Seb. K vs a Lentigo Maligna. Sharp boarder and more variable follicular openings of a Seb K, vs Atypical follicular openings of a Lentigo Maligna.( ? how long is long standing ) The odds are that this is a Seb K , but a shave excision for histology , to be 100% sure.

  7. What is your assessment? long-lasting light macule on the face of a patient of 60 years. The lesion looks like a Lentigo simplex he has since a long time .however melanoma can look like Lentigo and the size is changing.
    How do you evaluate lesions like this? The 3 point checklist is two ( irregular in color and shape) and asymmetric.
    What would you do next? Large excision biopsy of 3 mm margin of the entire lesion for the pathologist with good explanation of the context.

  8. The pigmented has change in size shape and pattern. I can see enough to call it a sebK: changed pigmented lesion needs excsional biopsy 2-3 mm margins : easy here

  9. Facial lesion , asymmetrical, changing, increasing in size . I will excuse lesion with a 2 mm margin , for possible LM or melanoma

  10. This type of lesion is really tricky for many GPs and many skin cancer doctors. Differentiation on dermoscopy is tricky if you are not expert. My advice is to do a shave excision biopsy on lesions like this. Easy and quick – put in plenty of local to raise the skin up and then just carefully shave the entire lesion. That will give a diagnosis and will be an effective treatment for many lesions

    1. While I agree shave excisions are great for these little flat pigmented lesions, I opted for an excisional biopsy here because it was in his beard area and I was concerned he would be left with an obvious bald patch. It healed well and the scar was hidden in his beard.