This 30 yo woman has noticed an enlarging pigmented lesion in her right axilla for almost a year. Her mother, a registered nurse, asked her to see a dermatologist. Her husband did not notice it.
The patient has Type II skin. The general cutaneous exam was unremarkable save for a 1.2 cm in diameter barely elevated plaque. There is a play of pigment and outline is irregular.
An excisional biopsy was performed.
Pathology: Malignant melanoma in situ , superficial spreading type. (Read by H. Byers of BU Skin Path who took photomicrographs) "The specimen exhibits a marked nested and lentiginous melanocytic proliferation with large severely atypical epithelioid cells. There is irregular nesting, focal confluent lentiginous melanocytic proliferation and cellular dyshesion."
She is scheduled for a wider excision, 0.5 cm on either side. No further work-up other than regular follow-up visits.
Your thoughts are appreciated.
You did the right job regarding diagnosis and management.But it is preferable to do wider excision from the start in such suspicious case.All the best for you and your patient
ReplyDeletekhalifa sharquie