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

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.

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Dermoscopy revealed:

• an atypical reticular pattern
• regular streaks
• blue hint

This lesion was excised and pathology revealed a Reed nevus.

A black tumor on a thigh.

A 52 -year-old woman consulted for her moles. Examination revealed this little ugly duckling on her left thigh.

Dermoscopy revealed:

• irregular colours
• a blue white veil
• irregular pseudopods

in favor of a spitzoïd melanoma

A red tumor on a thigh

A 3-year-girl was brought for examination of this non pigmented lesioon on her thigh.

Dermoscopy (X20) revealed a vascular pattern with predominance of dotted vessels.

Same image with a heavier pressure on dermoscope: vessels are less visible.

Clinical and dermoscopic images were in favor of a Spitz nevus.

A red tumor on a leg

A 42-year-old patient consulted for this red tumor present on his right leg for 1 year.

Dermoscopy revealed :

• no pigment network
• arborizing vessels

in favor of a basal cell carcinoma

Pectoral lesion

A 52-year-old man presented this pectoral lesion. No clinical history was available.

Dermoscopy revealed:

• multiple colours
• a multi-component pattern
• an atypical reticular pattern
• some pseudopods 
• irregular blotches
• regression areas

Pathology confirmed the diagnosis of superficial spreading melanoma.

A third nipple.

A 28-year-old man consulted for this pigmented lesion located under his nipple. He was thinking this lesion was present since birth.

Dermoscopy revealed a central hypo-pigmented area with a peripheral pigmented reticulation.
This feature looks like a dermatofibroma

This lesion was a surnumerary nipple (accessory nipple)


References:
1 - Blum A., Roehm S. Accessory nipple looks like dermatofibroma in dermoscopy. 
Arch Dermatol 2003 Jul; 139 (7): 948-9


2- Oztas MO, Gurer MA. Dermoscopic features of accessory nipples. Int J Dermatol 2007; 46(10):1067-8

Back lesion

A 54-year-old woman consulted for this changing lesion on her back.

Dermoscopy revealed:

• multiple colours, irregular pigmentation
• a multi-component pattern
• an atypical reticular pattern
• irregular streaks (yellow arrow)
• irregular dots and globules (orange arrow)
• irregular blotches (green arrow)
• peppering, regression (white arrow)

Pathology revealed a superficial spreading melanoma (SSM) with a Breslow index at 0.33 mm

 

A 25-year-old man consulted presented a pigmented lesion on his back (lumbar area).

 

Dermoscopy revealed:

• a réticular pattern
• irregular streaks (pseudopods)

in favor of a Spitz nevus which was confirmed after excision.

Emerging on a forearm

A 73-year-old man consulted for a pigmented lesion on his right forearm. This lesion was not symmetrical and been recently discovered by patient.

Dermoscopy revealed:

• an asymmetrical pigmentation
• a disorganised and atypical reticular network
• an homogeneous area

This lesion was excised and pathology revealed a superficial spreading melanoma in situ. 

Red lesion

The same 65-year-old man presented a red lesion on his back.
Dermoscopy revealed:

• no signs for a melanocytic lesion
• thin arborizing vessels (green arrow)
• ulcerations (black arrow)
• blue gray globules (white arrow)

in favour of a basal cell carcinoma

Black lesion is back

A 65-year-old man consulted for a dark pigmented lesion on his back.
Dermoscopy revealed:

• absence of pigment network
• milia-like cysts
• comedo-like openings

in favor of a seborrheic keratosis.

Red nodule

A 62-year-old man consulted for a red tumor on his back.

Three dermoscopic pictures are exposed with different levels of pressure on the tumor. Vessels are well seen with a slight pressure.

Dermoscopy revealed arborizing vessels and a blue globule in favour of a basal cell carcinoma.

Forearm lesion

A 59-year-old woman consulted for this pigmented lesion on her right forearm.

Dermoscopy revealed:

• irregular pigmentation
• atypical reticular pattern
• irregular dots / globules
• brown dots
• regressive homogeneous area

in favor of a melanoma.

This lesion was excised and pathology revealed a superficial spreading melanoma with a Breslow index at 0,47mm

Scalp lesion

A 72-year-old man consulted for a rapidly growing black nodule on his scalp. (the scar is due to an operation 3 years before for a Bowen's disease).

Dermoscopy revealed a dark blotch. At the border, a blue white veil is present.

This lesion was excised and pathology revealed a nodular melanoma (Breslow index 2 mm)

A facial telangiectatic tumor

A 67-year-old woman consulted for this small lesion on her left cheek.


Dermoscopy was typical of a basal cell carcinoma: ulceration, arborizing vessels and a (subtle) leaf -like area.

Black tumor

A 79-year-old man with many dysplastic nevi, consulted for a nodular bleeding tumour on his back.

Dermoscopic examination was difficult because this lesion was bleeding.

Dermoscopy revealed a bluish pattern, blotches and a brown pigmentation at the border of this lesion.

Pathology revealed a nodular melanoma (Breslow index 3,3 mm).

Dermoscopy of lip pigmentation in a Laugier-Hunziker syndrome

Laugier-Hunziker syndrome is an acquired, benign, macular hyperpigmentation of buccal mucosa lips (and nails). Histologically, pigmentations are due to an accumulation of melanin in the basal layer keratinocytes and an increase in the number of melanophages in the submucosa and/or papillary dermis.

We report dermoscopic pictures of lip pigmentations in this syndrome.

In our case, dermoscopy revealed a reticular pattern and also linear or curvilinear streaks making a parallel pattern.

Reference:

Dermoscopic findings in Laugier-Hunziker syndrome. Gencoglan et al. Arch Dermatol. 2007; 143(5): 631-633

A red tumor

A 56-year-old woman consulted for a red lesion on her abdomen.

Dermoscopy revealed: regularly distributed hairpin-like vessels in favor of a seborrheic keratosis.

This lesion was excised and pathology confirmed the result.

Seborrheic keratosis is a cause of red tumor. Remind to rule out an amelanotic melanoma which is a great masquerader.

Fast growing tumor

A 65-year-woman consulted for this lesion on her left arm which was present for 3 months.

Dermoscopy revealed peripheral hairpin-like vessels on a whitish area, and a central brownish structureless area.

This lesion was excised and pathology revealed a kératoacanthoma.