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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 4000! You can review the archived cases and read the suggested diagnoses by users and the final comment by the contributors.
Case are uploaded each week day by 10 am UK time with the correct diagnosis will generally be posted at 8 pm UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

Case Number : Case 2967 - 19 November 2021 Posted By: Dr. Richard Carr

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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M40. 2 years pigmented lesion on the cheek, increasing in size, now 4mm. ?DN ?Melanoma

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Lentigo Maligna.  In first pic I see some solar damage. 

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Dr. Richard Carr


I favoured a radial growth phase superficial spreading malignant melanoma. There is microinvasive dermal disease and the risk of metastasis should be minimal. One can discuss with the patient the merits or otherwise of a re-excision but UK national guidelines state for pT1a melanomas patients should be offered a clinical margin of 1cm. If this was on my face I'd probably opt for a 3 to 5mm and clear histological margin after careful examination. I favour offering a personalised approach to treatment dependant on careful pathological assessment examination, taking into account clinico-pathological aspects (size, location etc) and consideration of risk-benefit applied to the individual.

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