A whitish lesion

A 48-year-old woman consulted for a whitish scar-like lesion on her back.  

Clinical picture: whitish scar-like lesion with a pigmented border. Patient has a background of former heavy sun exposure.

At dermoscopy:

• no signs in favor of a melanocytic lesion
• a structureless  scar-like white pattern
• pinkish areas without any vascular structures
• a peripheral pigmentation (red square) in favor of leaf-like areas

Pathology revealed a superficial basal cell carcinoma

Pigmented lesion on neck.

A 57 year-old-woman consulted for a pigmented lesion on her neck.

Dermoscopy revealed:

• no melanocytic structures
• a structureless pattern
• irregular blue gray dots/globules 

Pathology was in favor of a Bowen's disease.

A small lesion...

A 52-year-old woman consulted for a cutaneous check up.
Examination revealed this lesion.

Dermoscopy revealed:

• maple leaf-like areas (black arrow)
• blue ovoid nests (red circle)
• structureless area (red arrow)

This lesion was excised and pathology revealed a superficial basal cell carcinoma.

Dots in lines...

A 75-year-old man consulted for a pigmented lesion on his right ear. This lesion was located on helix.

Dermoscopy revealed a light brown structureless area with some brown dots arranged in lines in the periphery.

Focal arrangement of brown dots in lines (red arrows) is clearly seen on the dermoscopic picture above.

A biopsy was performed and revealed a Bowen's disease.

This arrangement of brown dots in lines has been recently reported in the Journal of American Academy of Dermatology * by H. Kittler and al. It is typical of pigmented Bowen's disease.

*A Cameron, C. Rosendahl, P. Tschandl, E. Riedl, H. Kittler. Dermatoscopy of pigmented Bowen's disease. J Am Acad Dermatol 2010; 62: 597-604.

Plantar nevus

A 25-year-old woman consulted for a pigmented lesion on her right foot.

Dermoscopy revealed a parallel furrow pattern and a whitish structureless area.

On the middle of this structureless area a keratotic lesion was noticed in favor of a callus.

An excision was performed and pathology revealed a benign melanocytic nevus.

The structureless area was caused by the chronic friction of this nevus against shoes.

Whitish area

A 17-year-old girl presented a pigmented lesion with a lateral  depigmentation.

Dermoscopy  revealed a globular pattern associated with a whitish structureless area. On this whitish area some vessels were observed. There were no signs of peppering.

This lesion was excised and pathology revealed a benign dermal melanocytic nevus with a fibrous involution.

Whitish structureless area can be observed in:

• fibrous involution
• after traumatism
• in case of regression (with peppering)

Keratoacanthoma

A 72-year-old man consulted for a rapidly enlarging tumor on his right forearm. The lesion appeared 3 to 4 months before.


The main clinical diagnosis was a keratoacanthoma.

Dermoscopy revealed:

• a central brownish structureless area corresponding to a central mass of keratin
• a whitish area with presence of elongated hairpin vessels
  

A central brownish structureless area (black circle) and hairpin vessels on a whitish background (white circle) are the two main dermoscopic signs in favor of a keratoacanthoma.

The diagnosis was confirmed by pathology after the complete excision of the tumor.

Blue nevus

A 43-year-old woman consulted for a dark bue lesion on her left buttock.

Dermoscopy revealed an homogeneous pattern made of bluish to white-blue structureless pigmentation, in favor of a blue nevus.

Compound melanocytic nevus

A 34-year-old woman consulted for an atypical pigmented lesion on her back.
Dermoscopy revealed an atypical broadened pigment network and a structureless area without other criteria for a melanoma.
It was excised and pathology revealed a compound melanocytic nevus with a lateral junctional extension.

Melanoma in situ

A 28-year-old man consulted for a pruritic pigmented lesion of his right shoulder.
Dermoscopy revealed an asymetric pattern with blue-gray globules and focal structureless areas. The lesion was excised and pathology revealed a melanoma in situ.






Other cases of melanoma
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Melanoma in situ

A 68-year-old man presented a pigmented lesion on his back. In dermoscopy the presence of a disorganized and broadened network, and a structureless area on the left side were in favor of a melanoma. The lesion was excised and pathology revealed a melanoma in situ.





Other cases of melanoma
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Atypical melanocytic nevus

A 28-year-old man consulted for this atypical nevus on his right thigh. The reticular pattern was asymetric and there was a featureless area on the left part. The patient had presented an alopecia areata, treated by PUVA (60 sessions) 3 years ago.
This lesion was excised and pathology revealed a junctional melanocytic nevus.

Traumatized nevus

A 25-year-old woman consulted for a nevus on her left knee which had been traumatized.
Dermoscopy revealed a cobblestone pattern and a white featureless area (loss of pigmentation) due to the traumatism.