Case discussion: How would you treat this patient? [17 October]

In this week’s case discussion, submitted by Dr Magdy Malek, we look at a 73-year-old male patient who presented for a full-body skin cancer check and this pigmented lesion was found on his lower back. The patient has a history of multiple melanomas in the past.

What do you think of the dermoscopy, and what would you do?

case discussion

Update

The lesion was shaved and histopathology revealed a Clark 2 melanoma with Breslow thickness 0.4mm. What next?

case discussion

 

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16 comments on “Case discussion: How would you treat this patient? [17 October]

  1. Strong history of Melanoma, This new lesion has asymmetrical colour, with areas of regression and deranged networking and pigmentation. I believe this is a Malignant Melanoma and needs excision biopsy first , viewing for wider excision later depends on the depth.

  2. Different shades and structure with dark blotch. Ugly duckling. Brown snd red must be taken serious. Excise it. DD; mm

  3. ASYMMETRICAL LESION WITH AREAS OF LIGHT AND DARK BROWN STRUCTURELESS, THERE IS A SHINY WHITE AREA AT 9 CLOCK, THERE ARE ONE OR TWO PERIPHERAL STREAKS AT 3 CLOCK
    MELANOMA FOR EXCISION WITH SAFETY MARGIN

  4. This is clinically a melanoma with depth so fully excise with 2 mm margins and await the depth to determine the margin for clearance ie 10- 20 mm or if SNB be required.

  5. Clinically a high-risk patient. A new lesion on his lower back?
    Dermatoscopically = Chaos: atypical; structure, colour and boarder. (a polaroid image would have been better)
    Atypical network, some irregular peripheral streaks. Irregular blotches, with many shades of brown. An erythematous area without blood vessels clearly seen.
    IMPRESSION= a superficial spreading melanoma until proved otherwise. The differential diagnoses would be an atypical lentiginous junctional naevus vs an irritated reticulated seborrhoeic keratosis.
    PLAN = a full excision with 2mm margins. Further management would be based on histology.

  6. The lesson is suspicious. It has iborder rregularity, areas of regression, , different colour and density.

    I will excise the lesion.

  7. The history almost enough to suggest ‘remove this lesion’–but has features of irregular pigmented clumping /assymetry to suggest another melanoma –wide excision

  8. FURTHER MANAGEMENT= A re excision with a 5mm margin + deep down to the fascia. 3 monthly skin checks for 1 year then 6 monthly for life

  9. Full re- excision with 10mm margin and down to fascia. Confirm nil change in classification that may need more aggressive management.
    Review 6 mnths and then annual skin checks.
    Suggest full body mapping.