Case discussion: How would you treat this patient? [11 April]

This week’s case discussion, submitted by Dr Terry Harvey, features a 49-year-old male patient who presents for a routine skin check and is concerned that a new lesion is present on his left medial foot. He has a history of four previous melanomas.

What do you make of the clinical and dermoscopy images? What would you do?

case discussion 

Here is the pathology report. What next?

– 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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22 comments on “Case discussion: How would you treat this patient? [11 April]

  1. New pigmented lesion in high risk patient. Ridge pattern of pigmentation. Melanoma until proven otherwise, so excision biopsy and go from there (probably could get it all with a 5mm punch)

  2. A previous history of melanoma and the dermoscopy of this acral lesion which shows more pigmentations in the Ridges and very little or no pigmentation of the grooves, makes it suspicious.
    Ex/b with 2mm margin is justified

  3. Peripheral ridge pattern pigmentation showing irregular color of two with dots/ clods. Having stated the history of 4 MM I would be cautious to excise to rule out any sinister malignant changes.

  4. Acral melanoma has to be excluded. Four melanoma p/h, and acral melanomas are aggressive in their spread, so would not want to miss one.
    Excision biopsy either with simple ellipse or a large punch.

  5. Clinical- New onset brownish macule in a previously known melanomas x 4 patient
    Dermoscopy- Parellel furrows, double dotted lines. Can see some ecrine pores as well. Irregularity of Colour pattern
    Melanoma unless otherwise proved
    Excision strongly recommended

  6. Pigmented lesion with variation of colors, clods, previous history of melanoma: Acral malignant melanoma, the next step would be a full thickness excisional biopsy with 2mm margin of normal skin

  7. really I can not see furrows or ridge patterns may be fibrillar.
    there are asymmetrical globules on periphery excision biopsy

  8. I am having trouble with the clarity of the dermoscope image – but it appears to have pigmentation in the ridges, so any hint of parallel ridge pattern – needs excisional biopsy with margins, and with the melanoma history, I would be more likely to do so

  9. The patient has a lesion for whom the 3-point checklist is zero. The lesion is symmetric in color and shape, any network, and any blue-white structure. It is a new nevus on the left medial foot. I will do an excision biopsy even if the lesion is benign because the patient has a history of four previous Melanoma. A new nevus on 49 years old people is a lesion that can degenerate and the lesion has more than 6mm. I will send the Biopsy to the pathologist and give a regular and closer appointment for consultations with the patient. I will examine even his regional lymph nodes and organs of predilection of melanoma metastasis.