Case discussion: How would you treat this patient? [2 May]

This week’s case discussion, submitted by Dr Jag S, features a 38-year-old male, with no previous skin cancer history, who presented with a new lesion on his back.

What do you make of this? What would you do?

case discussion

Update

Here is the pathology report. What next?

case discussion

– Prof David Wilkinson

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22 comments on “Case discussion: How would you treat this patient? [2 May]

  1. You can see irregular blotch area plus structurelesss area too in the centre. Very suspicious of melanoma

  2. This lesion is very suspicious of SS Melanoma in situ at least (?Malignant=Invasive).

    Clinically, this lesion shows:
    1. marked irregularity of border, asymmetry of colour & structures,
    2. the pigment network is lost, 3+ colours, pink centrally suggests regression.
    3. (Blue-grey veil is not seen here)

    Management plan :
    with 2/3 = very suspicious of Melanoma in ~18x11mm back lesion 38yr old man
    – examine for axillary & supraclavicular Lymphadenopathy
    – complete full skin examination
    – Urgently excise with 2mm margin in line of ribs.
    – from Pathology result, consider
    1. definitive WLE margin acc to Breslow depth;
    2. SLNB if >0.8mm Breslow thickness with LVI or >2mits/sqmm

  3. Ugly duckling – assymmetry colour, shape and structureless area
    Excision biopsy with 2mm margin
    ? Melanoma

  4. Excisional biopsy – new lesion that is very asymmetrical with altered network – need definitive diagnosis

  5. Asymmetrical in colour and shape. White clearings. Clues – multiple
    I would excise suspicious of MM.

  6. Chaos and clues for MM. Excision biopsy 2 mm margin or deep shave of whole lesion to confirm diagnosis and the definitive management

  7. There are 3 suspected lesions near each other. They are all pigmented and the one we have at 7 o clock has blue-white structures and it is irregular in the shape and in colour. I suspect a Melanoma. the other lesion can be a local extension of the Melanoma. I have to do an excision Biopsy deep and large ( 3mm) removing all the 3 lesions at the same time. I can advise continuing to do a dermoscopy of the body. We can find other lesions.

  8. Suspicious lesion , ugly duckling, areas of structureless, asymmetry, two colors

    2mm margin excisional biopsy

  9. This Severely atypical dysplastic naevus appears adequately excised (best checking with dermatopathologist if not familiar with reporting style).
    Prudent management:
    1. full skin examination to identify other lesions worthy of excision or (photo-) monitoring.
    2. as a surgeon, I would discharge patient with a letter explaining above Dx, back to the referring dermatologist / GP (who would also receive a copy of Patient Letter).