Case discussion: How would you treat this patient? [4 April]

This week we revisit an engaging case from Dr David Stewart, featuring a lesion identified on the left loin of a patient with sun-damaged skin.

See the clinical and dermoscopy images. What would you do next?

case discussion  


Here is the pathology report.

case discussion

– 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.



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21 comments on “Case discussion: How would you treat this patient? [4 April]

  1. Asymmetrical whorls /reticulations and lots of colour variation ? previous excision biopsy .Excise– and also consider lesion just medial with pigmentation

  2. Need elliptical excision to rule out melanoma.
    Gray blotch at 7 o clock margin, several depimented areas, chaotic lesion, in a patient with lot of sundamaged skin.

  3. The lesion is asymmetrical in shape and colour, There are areas with regression, blue/and purple changes, Distorted networking. They are features of Malignant Melanoma and needs at least Excision biopsy then wider excision based on the grade and depth.

  4. Asymmetry colour and pigmentation
    Blue grey veil
    ? melanoma
    for excision biopsy 2mm margin

  5. Chaotic PSL shoeing different shades and structure. Clods snd dots with blood vessels. Grayish brownish black structureless eccentric area. Some angulated lines. All are Sinister signs for malignancy. MM. excise.

  6. Recommend excision.This lesion ticks all the boxes. Asymmetrical shape, irregular border,multiple colours, atypical pigment network throughout, brown clods and possibly radial streaming. Chaotic

  7. This appears to be a pigmented lesion with chaotic features including an irregular colour (blue) and irregular patterns
    The clues include grey/blue colour, black clods, and possible polymorphic vessels (difficult to appreciate).
    There is a high suspicion of melanoma.
    I would do a diagnostic elliptical excision to excise the lesion in toto with a margin of 2mm.

  8. Asymmetry. Chaos. Multiple colours include grey, includes dark dots plus vessels are serpentine. Looks significant in size, however, regardless, is suspicious and requires removal.

  9. There is a degree of chaos at the bottom end of the picture and as a result I would remove the entire lesion as an excisional biopsy with 1-2 mm margins

  10. seb. keratosis with asymmetrical globules and blood vessels for punch biopsy at center

  11. A really instructive case, this week, speaking to the importance of naked eye review identifying the suspicious lesion that needs dermoscopy. Then, the importance of biopsy by complete removal etc

  12. Unfortunately, incomplete information was sent to the pathologist. However, The anatomy pathologist has confirmed the diagnostic visible on dermoscopy. The Breslow of 4 mm reveals the need for lymph nodes analyses, to do cartography of the whole body, and exams of other organs while looking for another location of the Melanoma or metastasis. In the meantime, I will organize a large and deep excision of the lesion and send it to the examination in order to be sure have removed it and to know the local extension.