Saturday, 28 June 2014





A 28-year-old patient consulted for this pigmented lesion on his right forearm.



Dermoscopy revealed:

  • multiple patches of pigmentation
  • without background pigmentation



Clinical and dermoscopic examination were in favor of an agminated nevus.

Differential diagnosis is nevus spilus: this one includes a tan background patch which is not present in agminated nevus.

Saturday, 21 June 2014





A 28-year-old woman consulted for this lesion on her right arm.


 Clinical picture


Dermoscopic picture



Dermoscopy revealed a targetoid lesion:

  • a central globular pattern (black arrow) in favor of a melanocytic nevus
  • a peripheral ecchymotic halo (red arrow)
  • a central hemorrhagic crust (yellow arrow)

This lesion was a hemosiderotic targetoid nevus.


Wednesday, 4 June 2014

Regression




A 48-year-old woman presented this pigmented lesion on her back. 



 1: clinical picture

 2: dermoscopic picture

3: dermoscopic picture

  4:  dermoscopic picture



Dermoscopy revealed:
  • regression areas with some depigmentation (green arrows and ovoid area)
  • blue gray structures (blue arrows) and blue gray dots (peppering)
  • linear irregular vessels (black arrows)



Lesion was excised and pathology revealed a regressive superficial spreading melanoma with Breslow index at  0,39 mm

Wednesday, 9 April 2014

Periocular blue nodule




A 28-year-old woman consulted for this slowly enlarging periocular tumor.









Dermoscopy revealed a bluish lesion with clear arborizing vessels.

This lesion was excised and pathology revealed a basal cell carcinoma.

Sunday, 30 March 2014

Acquired lesion on an ankle.

A 26-year-old man consulted for an acquired lesion for 4 years which was slowly enlarging on his right ankle.


 Clinical picture.


 Dermoscopic picture without pressure.


Dermoscopic picture with pressure.

This regular lesion has:
  • regular dotted vessels
  • a retiform depigmentation, or reticular depigmentation  
Clinical and dermoscopic patterns were in favor of a Spitz nevus.
Pathology confirmed this diagnosis.



Wednesday, 12 March 2014



A 41-year-old woman was examined for this lesion on her right thigh.



Dermoscopy revealed:

  • a multicomponent pattern
  • a reticular depigmentation  
  • chrysalis-like structures
  • polymorphous vessels including corkscrew vessels
Pathology revealed a superficial spreading melanoma with a Breslow index at 0.54mm

Tuesday, 11 February 2014

Melanoma ?



A 52-year-old woman consulted for an atypical pigmented lesion on her right thigh.

Dermoscopy revealed:

  • asymmetry
  • eccentric pigmentation
  • atypical reticular network
  • depigmentation
  • pink/red area
Clinical and dermoscopic images were in favor of a melanoma.
Lesion was excised and pathology revealed a dermatofibroma.

This case is interesting to show how a dermatofibroma may be atypical:
  • clinical examination: no induration at palpation and asymmetry of colours
  • dermoscopic features

Asymmetric pigmented lesion on a leg



A 25-year-old woman consulted for this pigmented lesion on her right leg.

Dermoscopy revealed:

  • asymmetry of color
  • atypical reticular network
Pathology was in favor of a melanoma in situ developed on a melanocytic nevus.

Wednesday, 16 October 2013

2 colors, 1 diagnosis



A 45-year-old woman was referred for this pigmented lesion with 2 colors.


Diagnosis was easy with dermoscopy:
  • comedo-like openings 
  • milia-like cysts
  • fissures and ridges 
  • network-like structures
  • sharp demarcation
in favor of a seborrheic keratosis

Wednesday, 9 October 2013

Chrysalis structures


A 51-year-old patient consulted for this lesion located on his back.


Dermoscopy revealed :

  • arborizing vessels
  • ulcerations
  • chrysalis structures


This lesion was a basal cell carcinoma.


Crystalline or chrysalis structures are white shiny streaks that can only be seen with polarized dermatoscopes.

Crystaline or chrysalis structures are most commonly observed in basal cell carcinoma and invasive melanomas and rarely seen in nevi. In melanoma,they reflect increased tumor thickness and progression. 
The significance of crystalline/chrysalis structures in the diagnosis of melanocytic and nonmelanocytic lesions. Y. Balagula, R.P. Braun, H. S. Rabinovitz et al.  J Am Acad Dermatol 2012;67:194.e1-8.

Wednesday, 25 September 2013

Black grapes



A 35-year-old man consulted for this blue lésion on his back.
Dermoscopy revealed a blue / black saccular pattern.


This lesion was typical of an angiokeratoma.

Friday, 12 July 2013

A small lesion...


A 52-year-old woman consulted for a cutaneous check up.
Examination revealed this lesion.


Dermoscopy revealed:

  • maple leaf-like areas (black arrow)
  • blue ovoid nests (red circle)
  • structureless area (red arrow)


This lesion was excised and pathology revealed a superficial basal cell carcinoma.

A slowly enlarging pigmented lesion


A 32-year-old woman consulted for a pigmented lesion on her left arm. This lesion was slowly enlarging for 3 years.

 Dermoscopy revealed:

  • an atypical reticular pattern with a total disorganization
  • multiple colors
  • signs of regression


 Two punch biopsies were performed.
Pathology was in favor of melanoma in situ.
Lesion was excised with a 0.5 margin.



Saturday, 27 April 2013

Mole with an eccentric pigmentation



A 40-year-old woman consulted for a mole with an eccentric hyper pigmentation.



Dermoscopy revealed:

  • an atypical reticular network
  • an eccentric dark reticular network
  • irregular brown dots
Lesion was excised and pathology revealed a melanoma in situ.































Sunday, 21 April 2013










A 60-year-old man consulted for this black-blue tumor on his back.
Patient did not know when this lesion appeared.

Dermoscopy revealed a homogenous blue pattern with whiter areas.

Two diagnosis were suspected:
- blue nevus
- melanoma

This lesion was excised and pathology revealed a blue nevus with fibrous involution


Monday, 31 December 2012

A pigmented lesion on back


A 75-year-old man consulted for this pigmented lesion on his back.
His skin was heavily sun exposed.
Clinical image is in the lower right corner.
Dermoscopy revealed:
- an atypical reticular network with different colours and disorganization
- a blue structureless area

This lesion was excised and pathology revealed a superficial spreading melanoma.
Breslow index was 0,30 mm.

Saturday, 1 September 2012

A new melanoma ?



A 30-year-old woman consulted for this black pigmented lesion on her 4th right toe. She mentioned to have tried to remove it with a blade and a needle.


Dermoscopy revealed a black homogeneous pattern.
A melanoma was suspected and lesion was surgically removed for pathology.

Pathology revealed a wart.

This is a quite unusual presentation for a wart.

Friday, 23 March 2012

Red lesion on an arm...


 A 50-year-old woman consulted for an enlarging lesion on her right arm;
Clinical examination revealed a red papular lesion with a slight pigmentation.



Dermoscopy revealed:

  •  atypical vascular pattern with polymorphous vessels, namely linear irregular vessels, dotted vessels
  • a small area of pigmentation (gray dots)
An excision was performed and pathology revealed an achromic melanoma with a Breslow index at 0.5mm.

Monday, 19 December 2011

Plantar lesion

1 - clinical image


A 28-year-old woman consulted for a plantar  bluish ulcerated lesion on his left foot which was present for 6 months.

Clinically, a melanoma was suspected.

2 - Dermoscopic image

Dermoscopy revealed:
  • blue hue
  • ulceration
  • blue ovoid nest
in favor of a basal cell carcinoma.

but this lesion was excised and pathology revealed an eccrine poroma (or eccrine acrospiroma).

Dermoscopic features of eccrine poroma have been described similar to basal cell carcinoma except the spoke-wheel areas and leaf-like structures (1)

1- A.Gatti, N. di Meo, G. Trevisan. Dermoscopy of eccrine acrospiroma masquerading as nodular malignant melanoma. ActaDermatoven APA Vol 19, 2010, No4, 23-25

Saturday, 3 December 2011

Scapular pigmented lesion



Due to an unfortunate accident, I am on a sick leave for a couple of months.
I am pleased to welcome Dr Eric Pierard'cases. Dr Pierard, dermatologist at private practice in Dunkerque, France has an important activity in dermato-oncology and is an expert in dermoscopy.







A 16-year-old man consulted for a left scapular pigmented lesion.
.

Dermoscopy revealed:
  • an atypical reticular pattern
  • regular streaks
  • blue hint
This lesion was excised and pathology revealed a Reed nevus.