He presented for a skin exam and was found to have an atypical pigmented lesion on his right shoulder. He remembers that this lesion had been biopsied years ago at another facility and he was told it was fine.
O/E: On the right shoulder there was a 1.2 mm in diameter irregularly pigmented macule with a play of color. The dermatoscopic picture was worrisome and he was scheduled for an excisional biopsy.
(The old biopsy report from 2007 was reviewed. This was a shave biopsy that showed a junctional nevus with mild to moderate atypia and margins were clear in the sections examined.)
Discussion: The patient has a thin melanoma arising in the site of a previous biopsy. This raises the question of whether shave biopsies of pigmented lesions are appropriate. At any rate, a thin melanoma, 0.3 mm thick just requires a wide-local excisison with one cm margins. Sentinel node biopsy is not indicated. The patient will have regular skin exams from this point on.