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1800 867 1390Case discussion: How would you treat this patient? [9 January]
Welcome to the first skin cancer case discussion of the new year! In this week’s case discussion, submitted by Dr David Stewart, we revisit the interesting case of a male patient with very sun-damaged skin who presented for a full skin check. This particular lesion caught the doctor’s attention.
What do you think, and what would you do next?
Update
Here is the pathology report. What now?
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1300 856 695
+44 203 514 0688
1800 867 1390
Chaos, pink, gray, blue gray, variable sized brown clods asymetricaly distributed, Melanoma, excision biopsy
Excise with 2mm margin ?melanoma
Dermoscopy suggests invasive melanoma. Excisional biopsy with 2mm margin is next step. Assessment and exclusion of distant metastases are essential at the first instance.
Suspicious 3/3.
For excision biopsy 2mm margins
Melanoma almost certain
My spot diagnosis is melanoma and need excisional biopsy.
A chaotic, (colour, structure and boarder) pigmented macule in collision with a seborrhoeic keratosis; L lower back.
Dermatoscopic image= 1 Blue structure. 2 White lines 3 Atypical network 4 Polymorphic BVs, a dense cluster of fine linear irregular and dotted BVs. 5 Less of a feature, irregular globules.
IMPRESSION = A superficial spreading lentiginous melanoma with a small focal invasive component. Until proved otherwise. Differential diagnosis = an atypical lentiginous junctional naevus vs a reticulated seborrhoeic keratosis, both are less likely.
PLAN= a full excision with 2mm margins and further management based on histology.
Irregular asymmetric pigmented patch with colors of brown and grey. White polarizing areas and increased vascular blush. Suspicious for melanoma. Excise with 2 mm margin
Chaos: asymmetry, marked blood vessels inf end, blue-grey haze
Suspicious for melanoma —> excise with 2mm margin initially
melanoma
Chaotic lesion with clues. For excisional biopsy.
Chaos, pink, gray, blue gray, variable sized brown clods asymetricaly distributed, Melanoma, excision biopsy
blotches, multiple colours, irregular dots, clods and irregular shape with white lines polarised, likely invasive melanoma, needs excision
Chaotic with different shades and structure. Excise to rule out MM.
This seems to me squamous cell carcinoma.plz correct me if I am wrong.
irregular margins, blue white structured,asymmetry- derma scrore 3-favours melanoma-suggested excision
Melanoma
Can I enquire? Why a shave biopsy for a pigmented lesion suspicious of MM? Why not an excision?