Basal cell carcinomas

A 75-year-old patient consulted for 3 lésions on her face and a lesion on her back with superficial ulcerations.

Dermoscopy 1: ulcerations, leaf-like areas

Dermoscopy 2: leaf-like areas, arborizing vessels, blue ovoid nest

Dermoscopy 3: leaf-like areas and arborizing vessels

Dermoscopy 4: leaf-like areas

All these lesions were superficial basal cell carcinomas

Superficial spreading melanoma on an arm

A 31-year-old man consulted for this pigmented lesion on his right arm.

Dermoscopy revealed pigmented lesion with the following dermoscopic signs:

• asymmetry of colors and shape
• regression area: depigmentation (black rectangle ) and blue gray dots (peppering) (yellow circle)
• atypical reticular network (brown rectangle)
• pseudopods (red arrow)

This lesion was excised and pathology confirmed the diagnosis of superficial spreading melanoma. Breslow index was 0,48 mm.

Facial lesion

A 55-year-old woman consulted for this pigmented lesion on her forehead.

This lesion was present for 3 years and had progressively changed of colour.

Dermoscopy revealed:

• multiple colours
• an atypical reticular network (white square)
• regression areas: depigmentation and blue grey dots (yellow square)
• irregular blotches (white circle)
• follicular plugs (red arrow)

This lesion was excised and pathology revealed a superficial spreading melanoma with a Breslow Index at 0.24mm.

Spitz nevus

A 23-year-old woman consulted for this pigmented lesion in her back.

Its history was unclear.

Clinically this lesion was an ugly duckling by comparison with other moles she had.

Dermoscopy revealed a reticular pattern, irregular globules especially visible at the periphery and some pseudopods.

Dermoscopic presentation was in favor of a Spitz nevus.

The lesion was excised and pathology confirmed the diagnosis.

Blue white veil

A 72-year-old man consulted for this black tumour on his back.

Dermoscopy revealed a sharply multi-coloured lesion without visible reticular pigment network covered by a central crust.

Most strikingly features were:

• a blue white veil
• irregular and thick vessels (see white square)

in favour of a melanoma.

Leaves

A 48-year-old woman presented a pigmented lesion on her sternal area:

Dermoscopy revealed:

• a non melanocytic pattern
• typical leaf-like structures
• one spoke wheel-like structure

in favour of a basal cell carcinoma

Typical leaf-like areas (click on the picture above to see enlargement)

A black heel...

A 65-year-old man consulted for a non healing ulceration on his right heel.

This ulceration had been occuring on a pigmented lesion present for 5 years. The clinical diagnosis of acral lentiginous melanoma was quite evident on examination.

Melanoma on the palms and soles have a distinct pigment network called parallel ridge pattern. The ridges are centered by white dots which are the openings of eccrine sweat ducts.

In our case, in certain areas parallel ridge pattern had disappeared and was replaced by uniform diffuse brown pigmentation (in which white dots are visible).

An acral lentiginous melanoma has to be differentiated from black heel (or subcorneal hemorrhage) which displays a parallel pattern.

A scalp tumour...

A 38-year-old woman presented since birth a localised parietal hairless orange-yellow plaque (1) This plaque was smooth and became verrucous during childhood.

The patient consulted because of the occurence of nodules (2) on the anterior part of the lesion.

Dermoscopy revealed yellow globular-like structures (1) on the posterior area.

On the nodules, arborizing tree vessels and blue ovoid nests were in favour of a basal cell carcinoma or a trichoblastoma

This lesion was biopsied  and pathology confirmed the diagnosis of basal cell carcinoma occuring on a Jadahsson nevus (nevus sebaceus)

Knowing that trichoblastomas are the tumors the most frequently reported as complication of nevus sebaceous  (2, 3) and that dermoscopy is not sufficently discriminative to distinguish a trichoblastoma from a basal cell carcinoma, we have to wait for the pathology result of the entire excision.

An update will be added within a month.

Litterature

1 -Nancy H. Kim et al.  The dermoscopic differential diagnosis of yellow lobularlike structures. Arch Dermatol 2008; 144 (7): 962.

2-Jaqueti et Al. Trichobastoma is the most common neoplasm debeloped in nevus sebaceus of Jadassohn: a clinicopathologic study of a series of 155 cases. Am J Dermatopathol 2000;22(2):108-18

3- Cribier et Al. Tumors arising in nevus sebaceus. A study of 596 cases. J Am Acad Dermatol 2000;42:263-8

melanoma

A 82-year-old woman consulted for this dark pigmented lesion on her left arm. Clinically a melanoma was suspected.

Dermoscopy revealed:

• a multi-coloured pattern
• a blue white veil
• blue gray dots
• whitish scar-like depigmentation
• polymorphous vessels including linear irregular vessels

Pigmented lesion on upper lip.

A 32 year-old woman consulted for this pigmented lesion present for 6 months.

Dermoscopy revealed:

• an atypical pseudonetwork
• rhomboidal structures
• irregular globules

A melanoma was suspected and this lesion was excised. Pathology revealed a superficial spreading melanoma in situ (Clark level I).