dermoscopy

Plantar lesion

2011-12-19T23:55:00.003+01:00

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

2011-12-03T19:58:00.001+01:00

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.

A black tumor on a thigh.

2011-09-13T15:10:00.000+02:00

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

2011-09-13T15:02:00.004+02:00

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

2011-09-13T14:40:00.004+02:00

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

2011-08-23T15:50:00.000+02:00

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.

2011-08-01T15:46:00.000+02:00

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

2011-07-22T16:09:00.000+02:00

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

2011-07-04T09:19:00.000+02:00

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

2011-05-23T15:57:00.000+02:00

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

2011-05-18T15:54:00.001+02:00

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

2011-05-18T15:34:00.000+02:00

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

2011-05-10T16:55:00.004+02:00

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

2011-05-07T08:07:00.003+02:00

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

2011-04-05T11:07:00.004+02:00

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

2011-02-01T16:47:00.006+01:00

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

2011-01-21T19:28:00.004+01:00

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

2011-01-08T10:40:00.004+01:00

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

2010-11-13T09:29:00.002+01:00

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

2010-11-12T12:39:00.005+01:00

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.

Regression

2010-10-21T14:40:00.009+02:00

A 61-year-old man consulted for a pigmented lesion on his back.

Clinically this lesion was asymmetrical with 2 colours: pink and black.

Dermoscopy revealed: regression signs with a pink area, blue gray dots with a peppering aspect.

Pathology report: fibrosis and inflammation, hypermelanosis. Melanophages developed on a 1 mm depth. Immunochemistry: anti-human A negative.

In conclusion, this lesion was a fully regressive melanoma.

We recommend to read this article:

Dermoscopy of fully regressive melanoma. L. Thomas and al.

The British Journal of Dermatology. 2008;158(6):1224-1229

2010-09-23T16:30:00.001+02:00

A 18-year-old man consulted for a pigmented lesion on his left heel.

Dermoscopy revealed a parallel ridge pattern and the presence of aggregated black globules, noticeably visible at the border of the lesion : this unique dermoscopic feature named "pebbles on the ridges" is typical of a subcorneal haemorrhage (or subcorcorneal hematoma, black heel).

Nice legs !

2010-09-17T17:29:00.005+02:00

A 59-year-old patient consulted for this white lesion on her back.

Dermoscopy confirmed easily the diagnosis showing the legs of this charming bug ! A tick !

Dorsal red plaque

2010-09-17T09:30:00.004+02:00

A 51-year-old man presented a slowly enlarging red plaque on his back.

Dermoscopy revealed:

absence of pigment network
thin arborizing vessels

A biopsy confirmed the diagnosis of superficial basal cell carcinoma.

In superficial BCC, vessels are often thinner than in other subtypes (nodular BCC).

Pigmented breast lesion

2010-08-24T08:13:00.002+02:00

A 28-year-old woman consulted for an enlarging pigmented lesion on her left breast.

Dermoscopy revealed:

a multi-colored pattern
a multicomponent pattern
asymmetry in 2 axes
an atypical reticular pattern
some atypical dots/globules
a scar-like depigmentation
a blue white veil

Pathology revealed a superficial spreading melanoma with a Breslow index at 0,5mm

dermoscopy

Plantar lesion

Scapular pigmented lesion

A black tumor on a thigh.

A red tumor on a thigh

A red tumor on a leg

Pectoral lesion

A third nipple.

Back lesion

Emerging on a forearm

Red lesion

Black lesion is back

Red nodule

Forearm lesion

Scalp lesion

A facial telangiectatic tumor

Black tumor

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.

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

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

A red tumor

Fast growing tumor

Regression

We recommend to read this article:

Nice legs !

Dorsal red plaque

Pigmented breast lesion

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