This 31 year old lady is not a patient of mine but her husband is and she was showing me a seborrhoeic keratosis on his back. I noticed the heart shaped lesion on her arm and when I questioned her about it she said she had first noticed it a week earlier on Valentine's day! She thought at that time that she noticed it because it had become darker and being Valentine's day she noticed the shape of a "love-heart". No past or family history of melanoma.
This following image has been annotated by Jeff Keir. His comments:-
With the retrospectoscope, I see grey circles and possibly some more "solid" adnexal involvement (see attached). The grey circles are not present on the normal surrounding skin and extend beyond the border of the obvious pigmented lesion - I wonder if they're evidence of the subclinical extension of atypical melanocytic hyperplasia?
Further photoshopped by Glenn. He claims that this reveals polygons.
I thank Lester Cowell for preparing this composite of manipulated images (below).
He will post his explanatory comments later on Sunday
(The "envelope" has not been revealed to Lester)
This 47 year old man had been referred to a dermatologist about this lesion but his appointment was several months away and a friend had suggested he see me. His wife was certain this had appeared and grown in about 12 months and she had insisted he see his GP about it. Again no past or family history of melanoma.
The pathologist has called one of these a melanoma and one a naevus.
What is your assessment?
I will post histology images at 1pm Qld time and the "envelope" at 3pm.
Editor's comment on the demonstration case
There were 54 comments from participants during the day. The lesion on the lady's arm was a level 1 melanoma arising in a junctional dysplastic lentiginous (Kossard) naevus. The lesion on the man's back was a benign naevus.
The diagnosis of the melanoma was in fact made by the patient's father who is the doctor who posted this case. He is convinced that it is only because of experience gained on this blog that he recognised the lesion as suspicious as soon as he saw it. An emphatic endorsement of this resource!
