Basal cell carcinoma

A 59-year-old man consulted for this tumor on his nose.

Dermoscopy was typically in favor of a basal cell carcinoma:

• arborizing blood vessels
• blue ovoid nest
• blue gray globules
• ulceration with congealed blood
  

Other cases of basal cell carcinomas: 

1 2 3 4 5 6 7 8 9  10 11 12 13 14 15 16 17 18 19 20 21

Basal cell carcinoma

A 89-year-old woman consulted for a pigmented lesion on her forehead. A basal cell carcinoma was the main clinical diagnosis.

On this picture, with a slight pressure of the dermoscope (polarized light dermoscopy), arborizing blood vessels are well seen.
Blue gray dots and globules are the other dermoscopic signs in favor of this basal cell carcinoma.

If the pressure of the dermoscope is too important, the blood vessels are not visible.

Vessels and red areas are better visualized with polarized light dermoscopy than with immersion contact dermoscopy (1)

References:
1 - Marghoob et al. Differences between polarized light dermoscopy and immersion contact dermoscopy for the evaluation of skin lesions. Arch Dermatol 2007 Mar;143(3):329-38

Atypical dermatofibroma

A 27-year-old woman consulted for a red firm lesion on her right cheek. This lesion was present for 1 year.

Picture 1: slight pressure of the dermoscope

Dermoscopy revealed a dotted vascular pattern (dotted vessels) as the only dermoscopic sign.
Clinical diagnoses were Spitz nevus, hypopigmented Clark nevus and amelanotic melanoma. Dotted vessels are typically reported in these 3 cutaneous tumors.

The lesion was excised and pathology revealed a dermatofibroma.

Picture 2: more pressure of the dermoscope

Similar cases of dermatofibroma with a dotted vascular pattern are rarely reported in the literature (1- 2 - 3)

Dermatofibromas are rare on the face. Cases of of dermatofibromas of the face have to be excised with wider margins in comparison with examples of classical dermatofibromas occuring on the extremities because of diffuse infiltration, involvement of deeper structures and a increased rate of local recurrences (4)


References:

1 - Color atlas of melanocytic lesions of the skin. Soyer et al. Ed Springer. Chapter V.2: Piccolo and Peris: page 287

2 - Pedro Zaballos et al. Dermoscopy of Dermatofibromas. A Prospective Morphological Study of 412 CasesArch Dermatol. 2008;144(1):75-83

3 - Ferrari A et al. Cutaneous amelanotic melanoma metastasis and dermatofibromas showing a dotted vascular pattern. Acta Derm Venereol. 2004;84(2):164-165.

4 - Mentzel et al. Benign fibrous histicocytoma (dermatofibroma) of the face. Clinicopathologic and immunohistochemical study of 34 cases associated with an aggressive clinical course. Am J Dermatopathol 2001; 23(5): 419 -26

Dermatofibroma

A 32-year-old woman consulted for this firm pigmented lesion on her left calf.

Dermoscopy revealed a pigmented network with multiple scar-like patches.
Typically the dermoscopic presentation of dermatofibromas consist in a central white scar-like patch with peripheral delicate pigment network. In this case the scar-like depigmentation was in patches and in a asymmetric disposition.

Zaballos et al * found multiple scarlike patches in 12.3% of dermatofibromas with
a scarlike patch and note that Blum and Bauer described a case of melanoma dermoscopically
mimicking a dermatofibroma with 4 central white scarlike patches and a delicate pigment network at the periphery.
* Arch Dermatol. 2008;144(1):75-83

Squamous cell carcinoma

A 74-year-old man consulted for a scalp tumor.


Dermoscopy revealed an unspecific whitish pattern with a scaly and crusted surface. A biopsy was performed and pathology was in favor of a squamous cell carcinoma (SCC).
Usually, the dermoscopic features of SCC are an unspecific pattern with scales and polymorphous blood vessels typically surrounded by a whitish halo.

Basal cell carcinoma

A 72-year-old man consulted for a red tumor on his left leg.


Dermoscopy revealed arborizing blood vessels, leaf-like structures and crusts in favor of a basal cell carcinoma.

Cherry hemangiomas

Case 1: 45-year-old woman with a solitary lesion on her left thigh.
Multiple, well-demarcated, red to blue-red structures typical of a saccular pattern.
Absence of pigment network, globules or streaks.
Diagnosis: cherry hemangioma



Case 2: red saccular pattern a the inferior pole of a pigmented lesion with a typical reticular pattern.
Diagnosis: cherry hemangioma associated with a melanocytic nevus or collision tumor.

Other cases of collision tumors: 1 2

Pink nevus

A 25-year-old woman with a phototype I consulted for a check-up of many nevi on her trunk and limbs. Two nevi were pink at the difference of the majority of them which were light brown.
Dermoscopy revealed dotted vessels disposed in a regular pattern.
Pink nevi are typicallly found in patients with fair skin type (phototypes I and II). If there are multiple pink lesions, a regular follow-up is advised as it is in this case.
If the lesion is solitary, it is better advised to remove it because differentiation from an achromic melanoma is not possible without pathology examination.


Other cases of pink nevi: 1

Litterature: Zalaudek and al, in Color atlas of melanocytic lesions of the skin. Springer Ed, Berlin, 2007

Fibrillar pattern

A 35-year-old woman consulted for a pigmented lesion on the sole of her left foot.
The dermoscopic feature was typical of a fibrillar pattern.
The fibrillar pattern was uniform and localized on the entire surface of the lesion. That was in favor of a benign acral melanocytic nevus.

The fibrillar pattern is a subtype of parallel furrow pattern observed on high-pressure areas and in hyperkeratotic areas.
Fibrillar pattern are quite never observed on palmar surface.
It has to be reminded that fibrillar pattern is in favor of a benign acral nevus only if it occupies the whole surface of the lesion. Melanomas can dysplay a fibrillar pattern in focal areas in a disorganized manner.

Reference:
Braun RP, Kopf AW, Marghoob AA. Comment on dermoscopy patterns of melanocytic nevi on the sole. J Am Acad Dermatol 2006; 55: 162-3

Other cases of fibrillar pattern: 1 2 3

Other cases of acral nevi:

1  2  3  4  5  6  7  8  9  10  11  

Meyerson's nevus

A 50-year-old man consulted for a pruritic pigmented lesion on his abdomen which rapidly changed with a peripheral erythema in favor of a Meyerson's nevus.

1a - Clinical view: eczematous halo around a pigmented nevus (before treatment)

Dermoscopy revealed a peripheral erythema circumsbring a pigmented lesion with a negative pigment network and regression areas.

1b - Dermoscopy: negative pigment network.

A short corticosteroid topical treatment was prescribed and after 10 days, the eczematous halo was less important. Dermoscopy revealed blue-gray areas in favour of regression.

2a -Clinical view after a corticosteroid topical treatment (10 days)

2b - Dermoscopic view: after a corticosteroid topical treatment.
Globular pattern with some blue-gray areas in favor of regression.

Because of these signs of regression, the lesion was excised. Pathology was in favour of a benign Meyerson's nevus.

Glomerular vessels

Glomerular vessels are typically found in Bowen disease.

In this case, glomerular vessels were the main clue for the diagnosis of Bowen disease for this 72-year-old woman who presented a reddish and well circumscrined plaque on her right forearm.


Other cases: 1 2 3