89-year-old man, extensively photodamaged skin with widespread skin tags and SK. This unique lesion on the right temple concerned me (attached files, dermoscopy and macroscopy pictures).
If this patient was in my clinic they would for sure get a biopsy - one has to be highly suspicious of melanoma, likely lentigo maligna melanoma. The blue-white veil, rhomboidal structures and ablation of hair follicles by pigment is concerning.
Highly suspicious of melanoma. If you perform a biopsy, which I recommend, be sure to also send the pictures to the pathologist and mark the spot where the biopsy was performed. This will help him/her greatly for the interpretation.
Thank you all. I'm planning an excisional biopsy instead of an incisional one. Then, if necessary, I expand the margins, what do you think?
Certainly an excisional biopsy will give you the best sample for diagnosis. It's hard to tell exactly the size of the lesion from your photo, but if it is quite large, 2-3 scouting punch biopsies can be done through the darkest/thickest areas (ie the area of blue-white veil). Also, hard to tell from the angle of your photo but this may lie over the temporal branch of the facial nerve and you should let him know the risks if an excision is going to be done.
le doute ne profite à personne
Proposer une longue biopsie intéressant les deux zones pathologiques puis agir selon le résultat
- coagulation superficielle pour ce qui serait kératose séborrhéique
- large et épaisse ablation pour le mélanome confirmé
I recommend 3-4 mapping punch biopsis (4mm), because the lesion is quite large.
I don`t see a single criterion for SebK! Very suspicious for melanoma
Dermoscopic pattern is typical for invasive melanoma (black hue) arising from solar lentigo (brown and GREY color). Complete surgical excision is recommended.
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