Incidentaloma

The patient is an 82 man who presented  for evaluation of a facial lesion.  That lesion was a basal cell carcinoma.  However a complete skin exam revealed a suspicious tumor on the right upper back. 

The patient has type III skin.  This "new" lesion on the back is an eight mm in diameter hypopigmented papule with an eccentrically placed  2 mm pigmented papule.

Clinical Photos:

Polarized View

Non-Polarized View

The Power of BLINK:
B = not benign
L = Lonely  1 point
I = Irregular pigment 1 point
N = (pt. unaware of lesion)
K = Known Dermatoscopic abnormalities  1 point
Score = 3  (Mandates biopsy)

The patient is scheduled for an excisional biopsy of the back lesion.  What are your thoughts at this time?

Biopsy shows this to be Malignant Melanoma
Type: unclassified
Thickness: 2.80 mm
Margins: signs of regression at ;ateral margin
Ulceration: absent
Mitoses: > 1/ mm squared
Vascular invasion: absent
Precursor lesion absent