Question: A 74 year old male is evaluated for a skin lesion that has recently changed in appearance. Punch biopsy is obtained; pathology reveals nodular melanoma with a maximum depth of 1.4 mm. Immunostains are performed that confirm the diagnosis. There is no clinical evidence of distant metastases. Which of the following treatment approaches is most appropriate in his case?

a) Excision with 1 mm margins

b) Wide local excision with 1 cm margins and sentinel lymph node biopsy

c) Primary chemotherapy

d) Ipilimumab

[Answer will be posted with next week's new question]

Answer to last week's question, “Comes and Goes" (May 13, 2019)

Melkersson-Rosenthal syndrome.