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Independents' Day

Snapshot diagnosis - What's the dark pigmented lesion?

Dr Mike Wyndham shares another uncommon diagnosis

Dr Mike Wyndham shares another uncommon diagnosis

The patient

This elderly woman rarely consulted and so it was some years since I had seen her. However, during a winter with multitudes of infection she requested a call-out. The first thing I noticed as she greeted me at the front door was the dark pigmented lesion on her face. Apparently, the lesion had been growing in size for the past couple of years.

Differential diagnosis

My initial instinct was that this was a lentigo maligna.

A seborrhoeic keratosis was a very outside possibility.

Getting on the right track

Seborrhoeic keratoses can be pigmented but are highly unlikely to grow to this size and continue to grow. The lesion's colour and thickness is quite variable and it does not have the cracked surface you see on a seborrhoeic keratosis. The patient was very reluctant to seek treatment for this lentigo maligna.

Outcome and treatment

As a compromise I sent this picture to one of our local dermatologists. He suggested using cryotherapy and failing that applying imiquimod (not licensed for this condition). Not surprisingly, she refused.

Dr Mike Wyndham is a GP in Edgware, north London

lentigo maligna

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