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1800 867 1390Case discussion: How would you treat this patient? [26 September]
In this week’s case discussion, we look at a pigmented lesion that Dr Ovida Vipulaguna found on his hand, and he is concerned it may be suspicious.
What do you think of the lesion and what would you do?
Update
The result is below. What next?
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1300 856 695
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1800 867 1390
Need biopsy
It’s a pigmented lesion to be sure but its only 1mm in size.
So I don’t think it is possible to pass judgement on ‘suspicious’ or not.
However because it is a doctor’s hand I would take it off with a 4mm punch and be done with it.
Small asymmetrical pigmented lesion that crosses over both ridges and furrows of the palm.
Using the BRAAF algorithm I’d say it’s a 4-5?
Excision biopsy
Suspicious, excision biopsy
Not suspicious.
No need for biopsy
Irregular
Paralell ridges
BIopsy
From what I can the lesion is irregular and appears to have crossed the reit lines I would excise with a small margin
Looks suspicious, will do 2 mm punch biopsy , review in 1 week.
It’s most likely a lentigo with pigmentation incontinence.
Serial observation would be the best approach.
Excision biopsy if patient highly anxious.
While in an unusual area for a Melanoma the medical concern anxiety —remove with 4mm punch biopsy
Interpretation of 8 Kb image is fraught with hazard. Reliable distinction of PFP and PRP is not possible in this case.
A positive note, of all sites melanoma are recorded , those from the palmar aspect of hand have a very very low incidence.
It requires complete excision not biopsy and then his to pathology.
It is a New Pigmentes macule. It’s Irregular and a biopsy is indicated.
Not very clear however it’s one colour but I could see a two lines in ridge with a cross. So the best to rule out any sinister is to biopsy 4 mm.
Is it new ? It may be a dysplastic naevus . I would observe . The small size makes diagnosis less certain
too small to be assessed, reassess in 4 months and check interval growth. then decide on need for a shave
while small pigmented lesions on glaborous skin do cause concern.
the pigment does seem to be concentrated in dermal furrows – less concerning, but detail magnification is lacking.
If smudging of the palmar pigmented skin ridges is seen / evolves, I would advise narrow excision Bx.
Pigmented lesion with irregular borders? Melanoma
Excision biopsy is advised
Observe and monitor for changes
Observe and monitor for changes
Hand is susceptible to bruises: monitor vs bx
Clinically = a new small acral pigmented lesion on the hand
Dermatoscopic image = hard to say much re the size of the lesion and the image. A brown structureless lesion that crosses furrows and ridges with an irregular margin
Impression= Because the lesion is so small and the dermatoscopic image gives no alarming clues for an acral melanoma, this is most likely an acral lentiginous lesion. The clinical presentation trumps the Dermatoscopic image. That is a new acral pigmented lesion, hence an excision biopsy with a 3-4mm punch to exclude an early acral melanoma. Equally one could do another dermatoscopic image in 4-6 months, if no change then just monitor the lesion.
Suggest looking hard for similiar lesions elsewhere : it could be reassuring
Its simple enough to photograph and watch.
I dont find the image compelling for immediate removal .
I like that your asking other doctors opinions: how often do we manage our own health with out checking.
You could someone non medical …” Sir, I am reading your palm ….and I see surgery in the near future “
Well done for removing this. This must be one of the smallest detected acral lentiginous melanomas. This melanoma will need a 5mm re excision re it is insitu. An elliptical excision should be possible re the lesion is so small.
Refer on to hand/plastic surgeon for excision with 5mm margins. Suggest full skin check in light of the above lesion.
Maybe I am late in expressing an opinion but there are some salient points I would like o make.
Thick skin does not shave well nor is it very malleable hence an elliptic 2mm biopsy I would consider would give the best cosmetic result and biopsy excision for histopathology. This could simply be done here in line with her natural creases.
Thick skin normally is not pigmented so any new pigmentated lesion needs to be considered highly suspicious.
This lesion has a dermoscopic polygon.
All these factors make the first to be considered differential diagnosis to be a melanoma. Excision biopsy therefore required.