Case discussion: How would you treat this patient? [30 May]

This week we revisit an engaging case from Dr Tim Aung. A 45-year-old female patient came for her regular skin check and this lesion was noted.

Please review the clinical and dermoscopic images below. What would you do, and why?

case discussion

Update

Here is the pathology result. What do you think?

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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24 comments on “Case discussion: How would you treat this patient? [30 May]

  1. Asymmetrical lesion with peripheral black clods and eccentric structureless area
    For 2 mm excision biopsy

  2. This is a pigmented lesion with multiple melanoma like features.
    Lesion has asymmetric pattern, atypical network, negative network, atypical dots and globules with some peppering .
    Biopsy is indicated.

  3. Part of this lesion looks like a dysplastic nevus.However the upper 1/3 has clumping or clods of pigmentation, And along with the asymmetry I would be concerned about MIS, and therefore do a excision biopsy with the 2 mm margin

  4. Ugly duckling. Areas of hypopigmentation and irreg pigmenration. For excision biopsy and histopath. MM?

  5. One stand out PSL showing two shades of colour. The top part shows dark blotch. Excise to rule out MM

  6. Junctions nevi consisting of seborrheic area top end and atypical network constructed of many seperate dots, structures , etc , suggesting melanocytic involvement. Biopsy.

  7. This pigmented lesion is asymmetric in color and shape, there is any network but kind of blue-white structures in the proximal extremity. The 3 point checklist is 2, the lesion is suspicious It is better to do an excision biopsy of 3mm margin and send it to the pathologist

  8. Treat it as melanoma:2 options-*0.5-1cm margins initially.
    *narrow margins initially and wide resection-depending on the histo.

  9. Asymmetrical lesion with abnormal network , Score 2/3, Needs excision biopsy with 2mm margin.

  10. Appears to have an eccentric structure less area, so it would be reasonable to excise biopsy with 2mm margins. DDx dysplastic naevus
    I note she has fair skin and a few naevi

  11. The lesion is asymmetrical in colour, the networking seems to be distorted, there is an area of regression which all together raises high suspicious of Malignant Melanoma.

  12. Possibly a combined Nevus but I would not risk it and would excise as suspicious for melanoma
    Asymmetric in shape & colour
    Atypical network

  13. Pigmented with 2 different structural areas.
    Along kohler lines suggests seborrheic keratosis. However superior area has dark dots and irregularity in structure so suspicious of lentigo maligna or MIS.
    I can’t feel texture of lesion or judge if raised or flat from picture.
    This needs excision biopsy with at least 2mm margins. In this area of back it would be just as easy to do full 5mm margin ellipse excision

  14. I’ve read the report, so have hindsight – but I would have done the same as the poster and either ellipse excised or at least conducted a shave biopsy. It is irregular in shape and colour and has some areas of clearing. I would far rather remove a potential MM than leave it. I can live with a small scar – I cannot live with a MM getting larger!