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

Brachial melanoma

A 54-year-old man had a rapidly growing lesion on his right back for 6 months.

Dermoscopy revealed:

• a vascular pattern with some polymorphous and atypical vessels
• peripheral pigmentation
• irregular globules
• eccentric blotches

Pathology revealed a superficial spreading melanoma with Breslow index at 1.53 mm

Starburst pattern

A 43-year-old man consulted for this acquired pigmented lesion on his left leg.

Dermoscopy revealed:

• a central blotch
• a regular starburst pattern

 Two diagnoses were evoked: Reed nevus or melanoma. Regular blotch and symmetrical starburst pattern favored Reed nevus.

Lesion was excised and pathology revealed a superficial spreading melanoma with a Breslow index at 0.28mm.

An ugly duckling

A 26-year-old woman consulted for many moles. One of them was considered "an ugly duckling".

Dermoscopy revealed:

• an irregular blotch
• asymmetry of form
• chrysalis-like structures

Pathology revealed a superficial spreading melanoma (SSM) with a Breslow index at 0,6mm

A 32-year-old man consulted for this enlarging pigmented lesion.

Clinical presentation: multiple couleurs, asymmetry

Dermoscopy revealed:

• multiple colors
• irregular dots
• pink structureless area
• irregular blotch
• regression

This lesion was easily diagnosed superficial spreading melanoma.

Pathology revealed a superficial spreading melanoma with a Breslow index at 0.5mm

Regression

A 48-year-old woman presented this pigmented lesion on her back. 

 1: clinical picture

 2: dermoscopic picture

3: dermoscopic picture

  4:  dermoscopic picture

Dermoscopy revealed:

• regression areas with some depigmentation (green arrows and ovoid area)
• blue gray structures (blue arrows) and blue gray dots (peppering)
• linear irregular vessels (black arrows)

Lesion was excised and pathology revealed a regressive superficial spreading melanoma with Breslow index at  0,39 mm

A 41-year-old woman was examined for this lesion on her right thigh.

Dermoscopy revealed:

• a multicomponent pattern
• a reticular depigmentation  
• chrysalis-like structures
• polymorphous vessels including corkscrew vessels

Pathology revealed a superficial spreading melanoma with a Breslow index at 0.54mm

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.

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

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

Pigmented breast lesion

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

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.

Facial lesion

A 55-year-old woman consulted for this pigmented lesion on her forehead.

This lesion was present for 3 years and had progressively changed of colour.

Dermoscopy revealed:

• multiple colours
• an atypical reticular network (white square)
• regression areas: depigmentation and blue grey dots (yellow square)
• irregular blotches (white circle)
• follicular plugs (red arrow)

This lesion was excised and pathology revealed a superficial spreading melanoma with a Breslow Index at 0.24mm.

Blue white veil

A 72-year-old man consulted for this black tumour on his back.

Dermoscopy revealed a sharply multi-coloured lesion without visible reticular pigment network covered by a central crust.

Most strikingly features were:

• a blue white veil
• irregular and thick vessels (see white square)

in favour of a melanoma.