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Melanoma — SCE Dermatology MCQ

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ModerateSkin CancerMelanomaSCE Dermatology

A 27-year-old man with Fitzpatrick skin type III presents with a pigmented lesion on his back. Dermoscopy reveals an asymmetric multicomponent pattern with an irregular pigment network, blue-white veil, and irregular dots and globules. What is the most appropriate management?

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Correct answer: B — Excisional biopsy with 2 mm clinical margins

The dermoscopic features described (asymmetric multicomponent pattern, irregular pigment network, blue-white veil, irregular dots/globules) are highly suspicious for melanoma. The appropriate initial management is excisional biopsy with narrow (2 mm) clinical margins to obtain full histological assessment including Breslow thickness. Wide local excision margins are determined only after histological assessment. Punch biopsy may under-sample the lesion. Serial monitoring of a suspicious lesion risks delay in diagnosis.

Reference: BAD 2017 Melanoma Guidelines; BAD Dermoscopy Guidelines