Pigmented Lesion Case Article

Question 1

70 years presented with longstanding pigmented lesion of right ear. Previous histo 2 years ago from 2mm punch - unstable lentigo. Pt has not notcied change.

Diagnosis?

Answer 1

Lentigo maligna - rhomboid structures, perifollicular pigment, asymmetry, grey network, annular granular sturctures

Question 2

Lentigo maligna - what is it?

Answer 2

Melanoma in situ
Elderly
Chronic sun exposure

Histo - unstable solar lentigo - precursor to LMM

Question 3

Why the the original biopsy not show correct diagnosis

Answer 3

Because why punch biopsy a pigmented lesion???????????

Maybe was not LM back then.

Question 4

What shouldve been performed?

Answer 4

Shave or excision.
Because its ear - shave was the best option.

Question 5

Margins for MIS/LM.

Answer 5

5-10mm. Reexcision may be necessary. Closure in a way should not distort margin.

Refer for MMS

has very high recurrence rates 6-20%

Question 6

70 years presented with longstanding pigmented lesion of right ear. Previous histo 2 years ago from 2mm punch - unstable lentigo. Pt has not noticed change.

Post-op clear margins. Next management steps?

Answer 6

Regular skin checks - yearly.
Self examination.
First degree relatives should have a full skin exam.

Question 7

70 years presented with longstanding pigmented lesion of right ear. Previous histo 2 years ago from 2mm punch - unstable lentigo. Pt has not notcied change.

2 lessons from this case

Answer 7

1. Take representative biopsy - pigmented - must take all.
2. If discordence between histo and clinical - > rebiopsy and discuss with derm.