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Saturday 31 May 2008

Strawberry appearance


Facial non pigmented actinic keratoses (AKs) display 4 main dermoscopic features:
  1. erythema, with a pink-to-red pseudonetwork surrounding the hair follicles
  2. white-to-yellow surface scale
  3. fine, linear-wavy vessels surrounding the hair follicles
  4. hair follicle openings filled with yellowish keratotic plugs and/or surrounded by a white halo
These features combined to produce a strawberry’ appearance.

Strawberry appearance in a non pigmented AK

Strawberry appearance in a slightly pigmented AK

Other cases of AKs:
1

Literature:
I. Zalaudek, J. Giacomel, G. Argenziano, R. Hofmann-Wellenhof, T. Micantonio, A. Di Stefani, M. Oliviero, H. Rabinovitz, H.P. Soyer, K. Peris (2006) Dermoscopy of facial nonpigmented actinic keratosis. British Journal of Dermatology 2006: 155 (5) , 951–956

Wednesday 28 May 2008

Dermatofibroma with vascular structures


A 54-year-old woman consulted for a firm reddish tumor on her left thigh.
Dermoscopy revealed a central scarlike white patch in favor of a dermatofibroma and peripheral vascular structures: peripheral erythema and linear-irregular vessels.

peripheral erythema and linear-irregular vessels

Vascular structures are found in 29 to 49% of dermatofibromas, including erythema, dotted vessels, coma vessels, hairpin vessels, glomerular vessels, telangiectasias, linear-irregular vessels, polymorphous/atypical vessels.

Litterature:
Dermoscopy of dermatofibromas. A Prospective Morphological Study of 412 Cases
P. Zaballos, S. Puig, A. Llambrich, J. Malvehy, Arch Dermatol. 2008;144(1):75-83

Wednesday 14 May 2008

Arborizing tree vessels


A 68-year-old man consulted for an ulcerated burgeoning tumor on his right calf.
Clinically, many diagnoses were possible: amelanotic melanoma, basal cell carcinoma, squamous cell carcinoma, Merckel carcinoma.
Dermoscopy revealed an homogeneous pattern with arborizing tree vessels in favor of a basal cell carcinoma which was confirmed by a biopsy.

Saturday 10 May 2008

Peppering


A 85-year-old woman consulted for a slowly enlarging pigmented lesion on her right cheek


Dermoscopy revealed a pseudonetwork which is characteristic of facial pigmented lesions.
Furthermore, dermoscopy showed multiple slate-grays dots or pepper-like granules realizing a typical an annular-granular pattern or peppering in favor of a lentigo maligna melanoma. A biopsy confirmed this diagnosis.


Peperring

Peppering or annular-granular pattern can also be present in lichen planus-like keratosis and actinic keratosis.
Some lentigo maligna melanomas exhibit this structure.

Atypical nevus


A 32-year-old woman consulted for a mole check-up.
Clinical examination revealed the greatest mole localized on her left scapular area.
At dermoscopy, this lesion featured a pink veil, irregular streaks, irregular globules, an atypical reticular pattern, linear irregular vessels.


Irregular globules.

Polymorphous vessels including irregular linear vessels.

Irregular streaks.

Two diagnoses were possible: superficial spreading melanoma or atypical nevus. The patient did not mention any changing in surface or borders.
This lesion was excised and pathology revealed an atypical nevus ( compound) with a slight irritation.

Monday 5 May 2008

Homogeneous blue pattern

A 65-year-old man presented 6 blue lesions located on his trunk. Dermoscopy revealed a blue structure-less pattern (homogeneous blue pattern).
This patient had been treated 10 years before for a leukaemia. These blue lesions with blue homogeneous patterns not well demarcated corresponded to radiotherapy tattoos.

Radiotherapy tattoo

Radiotherapy tattoo

The main other cause of blue homogeneous pattern is blue nevus.
Here are above two examples of blue nevi.

Blue nevus

Blue nevus

Saturday 3 May 2008

Blotch


Blotch (or black lamella) is a black or dark brown pigmentation.
Blotch is formed by a large quantity of melanin pigment in the epidermis and / or dermis.
Here is a case of melanocytic junctional nevus where a blotch is covering its largest area.
In malanomas, blotches are often irregular.

Peripheral reticular pigmentation


In this case of dermatofibroma, we can see a central white patch with a delicate peripheral pigment network. In the former case of dermatofibroma, the pigmentation was not reticulated.

Dermatofibroma, actinic lentigo and flat seborrheic keratosis are the only non-melanocytic lesions which display a pigment network.

Other cases of dermatofibromas
1 2 3 4 5 6 7 8 9 10 11 12 13 14