A close shave with a recurrent pigmented facial skin lesion

When shave biopsy is not the best option

A 76-year-old man presents with a new pigmented macule extending from a surgical scar on his chin, as shown in the top image.

Dermatoscopically (bottom image) the lesion is asymmetrical, and the border — not being uniformly abrupt — is not consistent with solar lentigo.

A perifollicular grey circle (H15) in such a facial lesion is a clue to malignancy.

Seven years earlier, the patient underwent a shave biopsy of a 7x7mm macule at the site, which was reported to be a “lentiginous dysplastic naevus”.

Three years later, a 7x10mm lesion was excised from the site and reported to be a (recurrent) “lentiginous dysplastic naevus”.

Now, excision biopsy of the lesion, including the total area of the scar, reveals melanoma in situ extending from a surgical scar. Appropriate wide, deep re-excision is performed.