Case 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?

case discussion

Update

Here is the pathology report. What now?

case discussion

case discussion

 

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

  1. Chaos, pink, gray, blue gray, variable sized brown clods asymetricaly distributed, Melanoma, excision biopsy

  2. Dermoscopy suggests invasive melanoma. Excisional biopsy with 2mm margin is next step. Assessment and exclusion of distant metastases are essential at the first instance.

  3. 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.

  4. 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

  5. Chaos: asymmetry, marked blood vessels inf end, blue-grey haze
    Suspicious for melanoma —> excise with 2mm margin initially

  6. Chaos, pink, gray, blue gray, variable sized brown clods asymetricaly distributed, Melanoma, excision biopsy

  7. blotches, multiple colours, irregular dots, clods and irregular shape with white lines polarised, likely invasive melanoma, needs excision

  8. irregular margins, blue white structured,asymmetry- derma scrore 3-favours melanoma-suggested excision