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Case discussion: How would you treat this patient? [23 May]
Posted on by Abbie Shortt
This week’s case discussion, submitted by Dr Terry Harvey, features a 70-year-old male patient who noticed this area on his cheek enlarging over two years.
What is your differential and what would you do next?
Update
Shave biopsy showed MELANOMA IN-SITU, superficial spreading subtype, Clark level 1, at least 6mm in diameter. No dermal invasive melanoma is seen. There is associated superficial regression change. What would you do next?
– Prof David Wilkinson
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26 comments on “Case discussion: How would you treat this patient? [23 May]”
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in think is ? lentigo maligna melanoma
need excision biopsy
Classic Lentigo maligna melanoma…excision biopsy highly recommended!
Pigmented reticular lesion is suspicious 2/3 on dermoscopy.
Also suspicious on history.
Excision biopsy 2mm margins.
Lentigo maligna
Shave biopsy
I find this one difficult due to the orientation and size of the lesion. An 2mm margin excisional biopsy orientated with the long axis of the lesion would be fine, but then what happens when it comes back as a melanoma and we need a big margin? Orientation in this way for the definitive excision would be very difficult.
I know there are some issues with shaves, but this would be one I would be considering as complete a shave as I can manage as a biopsy.
Grey circles, blue gray veil – would do at least a 2mm punch biopsy to exclude Lentigo Maligna
Lentigo Maligna for excisional biopsy.
my differential diagnosis :
1-lentigo maligna melanoma as I see polygonal lines around hair follicles
2-solar lentigo
I would do excision biopsy or at least punch biopsy from the most suspicious area
Highly suspicious lesion for a melanoma.
Excise with 2mm clinical margins.
looks more like a seb k or compound melanocytic nevus with normal growth pattern. cannot see features warranting an excision even though enlarging in nature
it may be Hutchinson Freckle
do shave Bx
LMM
Deep Shave
Looks like Lentigo Maligna melanoma
Excision biopsy with a 2mm margin excised in a way that will leave me a definitive treatment plan option depending on the Histology report for the wider and deeper excision.
Where lesions feel very flat I have in past done a saucerization shave of the whole lesion. You just do not want to transect the deep margin and then not get a Breslow thickness if present
Blurry photos but can see rhomboidal with different shades and some follicular obliterations which fits with LMM. Excise.
This looks like HMF
EXCISION BIOPSY
ANNULAR GRANULAR [ATTERN
RHOMBOIDS
OBLITRATION OF HF
MELANOMA
LM
incisional or shave biopsy
Differentials
1.Lentigo Melanoma
2.BCC- telengectasia noted
Excision biopsy with 2mm margin.
Looks like either Malignant Melanoma or BCC
Total excision biopsy is my choice
large irregular with ugly duckling lesion, required excision biopsy of this lesion , I will refer to plastic surgeon
very dark PSL “ugly duckling” that has thick reticular lines, atypical network, different shades of brown, asymmetrical, “circle within a circle” highly suggestive of Lentigo maligna melanoma. Excision biopsy with 2-3 mm margin is recommended.
Assymetry; Blue/gray patches; Irregular thickened network
LM / Superficial Spreading MM until proven otherwise (possibly Seb K or naevus but seems unlikely).
Could do excision biopsy along the long axis of the lesion but this orientation is perpendicular to RSTLs.
Not clear but looks like a pre-existing scar just superior to the lesion running about 5 cm toward nose which could affect surgical plan. Definitive treatment likely a transposition flap to follow the RSTLs, so a deep shave covering as much of lesion as possible could be considered.
A pigmented lesion growing is a suspicious feature for a lesion. Please do an excision biopsy of a 3mm margin
It needs full excision. I would offer private referral but not public due to long wait times. I would be happy to fully excise this lesion if patient agreed. I think the site is relatively safe and easy to excise with primary closure.
EXCISE
Full excision with 5mm margins
Should be able to get good cosmetic outcome with ellipse.