Unexpected lesion on back
This older white patient was seen for a low risk skin cancer elsewhere, which was successfully treated.
At follow up, the whole skin was examined, leading to the finding of an unexpected pigmented lesion on the back. The patient had no idea it was there.
a close up view
Not very keen on that. Let’s get the scope to it.
remember our most basic basic algorithm, the 2-step.
1) is it melanocytic?
2) if so, could it be a melanoma? (alternatively, can we confidently say it is a benign entity?)
It is melanocytic because of reticular network clearly seen at 11 o’ clock and 4 o’clock. There are scraps of network elsewhere but it’s quite clear at these locations, see circles in 4th image which outline reticular network.
Having established this, can we say it is benign? Evidently not- much too chaotic with lots of grey and many different patterns. Never accept diffuse grey pigment in a melanocytic lesion. This has to go for histopathology. It was excised without delay and reported as a thin (0.5mm) melanoma. Such thin lesions are associated with a 95-100% cure rate. This is the whole point of the exercise, that is why we do this- to detect and cut out melanomas at an early stage before they spread. That is the way to reduce melanoma mortality.
LESSON I know we are all terribly busy, but really and truly patients who have a skin cancer diagnosed anywhere on their skin ought to get a full skin check. This is not the only time I have seen a patient present with a low risk skin cancer who had a high risk skin cancer elsewhere of which they had no awareness. It is not, as they say, rocket science.