Eccentric pigmentation

36-year-old woman with an atypical pigmented lesion on her left leg

Demoscopy revealed:

• an eccentric hyperpigmentation
• an atypical reticular network
• pseudopods

Pathology revealed a superficial spreading melanoma with Breslow index at 0.25 mm

A pigmented lesion on a shoulder

A 48-year-old man consulted for this pigmented lesion on his right shoulder.

Dermoscopy revealed:

• an atypical reticular pattern
• structureless areas with regression
• a retiform depigmentation (negative pigment network)

Pathology was in favor of a melanoma in situ.

Small, beware !

A 42-year-old man consulted for this small (4mm) pigmented lesion on his left calf.

Dermoscoy revealed:

• asymmetry of colors and structures
• some irregular blotches
• an atypical pigment network
• a radial streaming

Lesion was excised and pathology was in favor or a melanoma in situ.

Another back lesion.

A 34-year-old man consulted for a changing pigmented lesion on his back.

Dermoscopy revealed:

• asymmetry
• an atypical reticular pattern
• a regression area

Pathology revealed a melanoma in situ.

Thoracic pigmented lesion

Man 52 years old; Acquired pigmented lesion on chest.

Dermoscopy revealed:

• multiple colors
• asymmetry of form and structures
• an atypical network
• a blue white veil
• irregular dots and globules

Pathology revealed a melanoma in situ.

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.

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 a melanoma in situ.
Lesion was excised with a 0.5 margin.

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.

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.

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.

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. 

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

What is this lesion on a leg (2nd case) ?

A 71-year old woman consulted for this enlarging multi-colored lesion on her right leg.

Dermoscopy revealed:

• irregular pigmentation
• atypical pigment network
• negative pigment network
• irregularly distributed blotch
• blue-white veil

in favor of a melanoma.

An excision was performed and pathology revealed a superficial spreading melanoma in vertical extension, Clark level IV, and Breslow index at 3,1 mm.

Acquired pigmented lesion on a forearm

A 62-year-old woman consulted for an enlarging lesion on her right forearm.

Dermoscopy revealed an asymmetric reticular pattern with irregular dots.

Pathology revealed a superficial spreading melanoma with a Breslow index at 0.23mm.

A changing lesion on his back...

A 30-year-old man consulted for a pigmentend lesion on his back. His wife noticed this lesion was slowly changing.

Dermoscopy revealed an atypical a reticular network, an irregular pigmentation, and an atypical vascular pattern.

This lesion was excised and pathology revealed a superficial spreading melanoma with a vertical extension, with a Breslow index at 1.3mm.

Lost among black benign lesions....

A 72-year-old patient consulted for many pigmented lesions on his back. Most of them were seborrheic keratoses...........

............except this one.

Dermoscopy revealed:

• a multi- colored pattern
• a sharp demarcation
• an atypical reticular network
• a blue white veil

This lesion was excised and pathology revealed a superficial spreading melanoma (Breslow index 0.72mm) developed on a melanocytic nevus

Superficial spreading melanoma on an arm

A 31-year-old man consulted for this pigmented lesion on his right arm.

Dermoscopy revealed pigmented lesion with the following dermoscopic signs:

• asymmetry of colors and shape
• regression area: depigmentation (black rectangle ) and blue gray dots (peppering) (yellow circle)
• atypical reticular network (brown rectangle)
• pseudopods (red arrow)

This lesion was excised and pathology confirmed the diagnosis of superficial spreading melanoma. Breslow index was 0,48 mm.

scalp melanoma

A 65-year-old man consulted for this pigmented lesion on his scalp.

Dermoscopy revealed a disorganised atypical reticular network, blue gray dots and regression, irregular branched streaks.

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

Melanoma

Asymmetric lesion with pink homogeneous area

A 68-year old man consulted for an atypical pigmented lesion on his left lumbar area.

Dermoscopy revealed a melanocytic lesion characterized by:

• asymmetry
• an atypical pigment network
• a pink homogeneous area
• a white area of regression
• linear-irregular vessels
• polymorphous vessels

Polymorphous and linear-irregular vessels

Atypical pigment network (circle)

White area of regression (circle)

This lesion was highly suspicious of melanoma and excised.

Pathology revealed a superficial spreading melanoma (SSM) in situ developed on a melanocytic nevus developed on a melanocytic nevus