Teaching Cases

History

Case 3. This 79 year old patient with type 1 skin has had > 100 NMSC. This apparently new lesion on the anterior shoulder was noted at a 6 monthly check. Consider Solar lentigo, Seborrhoeic keratosis, Pigmented BCC, Nevus, Melanoma or Other.

Question: What is your clinical diagnosis?

Answer: Clinically this looks suspicious. It is a pigmented lesion with varying colours and a suggestion of regression.

Question: What is your dermatoscopic diagnosis?

Answer: There is no obvious network but the brown dots make it melanocytic. The amorphous blue area is suggestive of BCC but the adjacent pink area would be more likely in melanoma. The linear irregular vessels more support melanoma.

Question: What do you think the histology will show?

Answer: Histology showed " Sections show a superficial spreading malignant melanoma. The lesion is mostly in situ but does include a component which is Level 3 and 0.9 mm thick. Rare dermal mitotic figures are seen (less than 3 per square mm). No ulceration, regr

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