How would you manage this lesion on the scalp?

In this week's case discussion, submitted by Dr Bruce Poole, we look at a 54-year-old plumber with type 1 skin and a past history of melanoma 20 years ago.

The patient presents for a routine skin check four years after his last review (as he failed to respond to recall) and is unaware of this grey-brown, 6x4mm lesion on the scalp vertex.

What do you think of the dermoscopy? What is your action plan?

Update

A deep saucerising shave with visual 2mm radial margin was undertaken on the day. The histopathology showed melanoma in situ with follicular involvement.

Patient to have wider clearance with 5mm margin.

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