Three cases

Sorry for the three cases . I just remembered it was my turn to post today and this is an old draft I had in the system.

Case 1 60 years old female with this lesion on her leg. She said it had been present for at least 2 years and had not changed.

Case 2 Elderly lady with this lesion on her back.

Case 3 Recent lesion on the elbow. Only noted in the last 6 weeks.

Envelope for Case 1 Indeed a melanoma with Level 2 Bresslow 0.30mm. I have put some slides up. Interesting to compare the level of melanocytic chaos with Case 2.

Dr Con Pappas said...
Sorry Ian,
whats the envelope for case 2?

5:15 PM
Dr Ian McColl said...
Dysplastic junctional lentiginous nevus Con. I could not get my pathologist to call it a lentiginous melanoma, There were just a few nests of atypical melanocytes but mainly lentiginous single cell spread. Another pathologist might well have called it melanoma. As I said in a post above I shaved the whole thing off and declined to do a 5mm excision around it. I may be chancing my arm a bit.

simon clark said...
Case 2 is a nevus if the photomicrographs are truly representative.

9:39 PM
Dr Jeff Keir said...
"if the photomicrographs are truly representative" - and how can we bestknow that in this case of such a large lesion?

8:06 AM
simon clark said...
That is a very good question Jeff.

The first thing I want to know in this situation is whether all of the tissue was processed and how many slices of tissue were cut. I also want to know how many sections were cut.

The first two pieces of information should be on the report.

8:39 AM
Dr Ian McColl said...
Simon, I have copy slides showing that 12 slices were taken and all the lesion was submitted for examination.

10:05 AM
simon clark said...
Twelve slices would equate to a lesion about 30 - 40 mm in maximum dimension. That is adequate sampling of the lesion, and I think it is reasonable to call this a nevus (+ SK). There is no histological evidence of melanoma.

Were this lesion on me I would not want further excision.

10:57 AM
Ian Katz said...
I agree with Simon - absolutely nothing in the photos to be concerned about



Dr Ian McColl said...
Envelope Case 3 Sorry Alan this was also a melanoma Level 3 0.9mm with a couple of deep mitoses/mm. dense band of lymphocytes around the melanoma and infiltrating it.