Case discussion: How would you treat this patient? [21 November]

In this week’s case discussion, submitted by Dr Magdy Malek, we look at a 5x5mm lesion discovered on the back of the neck of an 68-year-old male patient during his routine full skin examination.

What do you think, and what would you do?

case discussion


A shave biopsy was performed and the histopathology revealed lentigo maligna. The lesion was completely excised with wide excision 5mm margin.

case discussion


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9 comments on “Case discussion: How would you treat this patient? [21 November]

  1. Asymmetry in colour and structures; atypical network; blue-grey structures = suspicious 3/3
    Likely melanoma
    Excision biopsy 2mm margins

  2. Chaos + structureless area .
    In the middle it looks like regression / scar.
    Can be a melanoma
    I would remove this with 2 mm margin.

  3. Although the edge from 12 to 3 o’clock resembles Seb K there is too much colour variability & asymmetry to ignore this. Excision all Biopsy required with suspicion of Melanoma in mind.

  4. Probably BCC but is possibility of melanoma.
    Definitely chaos of structure and colour of malignancy and requiring excision biopsy with 2 to 4mm margins as edges not distinct.
    Ultimate management depends on histology.

  5. Need for excision- possible MIS or melanoma–asymmetry, variation in colour and blue greyness,increased pigmentation/dark spots. Biopsy not representative.