Instructions
You are a medical student on placement in general practice, on a telehealth call. Kevin Lim, 52, is on video for the result of a lesion removed from his back two weeks ago.
Take a focused history
Explain the result and your management plan to the patient
Histopathology report - right upper back lesion
| Item | Value | Reference range |
|---|---|---|
| Specimen | Excision biopsy, 12 mm pigmented lesion, right upper back | - |
| Diagnosis | Invasive melanoma, superficial spreading type | - |
| Breslow thickness | 1.4 mm | - |
| Ulceration | Present | - |
| Mitotic rate | 2 mitoses/mm2 | - |
| Lymphovascular invasion | Not seen | - |
| Peripheral margin | Involved at one point; closest clearance 0.5 mm | - |
| Deep margin | Clear at 2 mm | - |
Comment: Tumour invades the dermis to a depth of 1.4 mm beneath an ulcerated epidermis. Given the positive peripheral margin, this excision should be regarded as diagnostic and incomplete. Case to be discussed at the metropolitan melanoma multidisciplinary meeting.