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1800 867 1390Case discussion: How would you treat this patient? [11 July]
This week, we discuss an interesting case from Dr Mokesh Raj. There are no clinical details for this patient, so please evaluate the case based on the dermoscopic image presented.
How would you evaluate this? If you were to do anything next, what would you do?
Update
Here is the pathology.
– Prof David Wilkinson
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1300 856 695
+44 203 514 0688
1800 867 1390
Punch biopsy or even a removal
white dots, irregular sharp， excision biopsy
Pigmented skin lesion , very irregular border , no uniform pattern , greyish area , pale / regressing , very suspicious of melanoma , would excise
Score of 2 asymmetry and atypical network. Excision biopsy with 2mm margin.
Highly suspicious for a melanoma
Excision Bx 2 mm margin
Excision biopsy of the lesion
Regressed nevi, reassess in 6 months
Irregular borders ,whorls, irregular pigmentation, grey nests, excision biopsy ? Melanoma
Although asymmetrical and technically two colours within with poor border – no real clues and has the ‘pore holes” etc.
Would discuss and probably consider shave with 2mm margin and review
Melanoma
Excision biopsy 2mm margins
No real structure. PSL showing uniform two colour area with some milias. SK vs Nevi.
Very suspicious of Melanoma
Wide excision ,histology
The lesion chaos and clues features I will do an excision biopsy
i think it is in face
there is undamaged skin
asymmetrical perifollicular hyperpigmentation
oblitration of hair follicles
shiny whit
melanoma
Flat pigmented macule ? on the face Some brown atypical follicular openings + grey with annular granular pigmentation+ romboids+ obliteration of some follicular openings. So a Lentigo Maligna until proved otherwise. Some features that could fit a pigmented actinic k re variable follicules ? rozettes but no scale . The margin is blurred , not sharp like a lentigo/seb K
IMPRESSION= Lentigo Maligna until proved otherwise, likely on the face
PLAN= a shave excision if on the face otherwise an excision with 2mm margins.
I see regression, and I would definitely do an excisional biopsy on this lesion.
I would favour 2 discrete lesions (collision) The lower looks more Seb K with white globules, clear edges and the top half looks more sinister for melanoma with central regression Enough for an excisonal biopsy 2-3mm margin.
Very likely seb K with the pattern of white clods and fairly well defined border. However very asymmetric and blue colour. If the macro suggested Seb K I would shave biopsy, if not excision biopsy to exclude melanoma
Highly suspicious for a melanoma. Excision biopsy of the lesion.
do nothing
Without clinical details and a clinical image, of course our approach is limited here. However, the lesion (on dermoscopy) is obviously “suspicious”. It seems to me that a shave biopsy would be an ideal approach here. Why? It looks to be small and flat, and there are 2 distinct aspects to the lesion, so worth getting a biopsy across of all it. Also, it if is not serious / benign (as the result shows) then no damage is done and also the lesion is effectively treated.