A 44-year-old man was concerned about an asymptomatic dark lesion on his upper back, which his spouse alleged was “new.” The rest of the examination was normal. Family and past medical histories were non-contributory.
Key point: The lesion is not very impressive, either in size or in morphologic features. However, on close examination, there is a “notch” in the superior pole, as well as some mild degree of pigment heterogeneity.
Treatment: The patient was quite happy to have the lesion excised with 5-mm margins. Histology disclosed a malignant melanoma in situ.
Note: In this case, being prudently cautious proved extremely beneficial. The history of a “new” lesion in a patient with almost no visible nevi, along with some very subtle gross features, led to the early recognition and elimination of a malignant melanoma.