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 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

A temporal lesion

A 60-year-old woman consulted for this temporal  pigmented lesion

 Dermoscopy revealed:

• blue-gray dots / globules
• leaf-like areas

Pathology was in favor of a basal cell carcinoma

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

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.

A pigmented lesion

A 32-year-old man had his moles checked up.

Dermoscopy revealed:

• whitish globules  / white cobblestone pattern
• Light-brown peripheral network

 In favor of an accessory nipple

Central white cobblestone pattern

 Reference:

Dermoscopy of accessory nipples in authors’ own study 

G. Kamińska-Winciorek, J. Szymszal, W. Silny

Postep Derm Alergol 2014; XXXI, 3: 127–133

A pigmented labial lesion

A 24-year-old woman consulted for a pigmented labial lesion.

Dermoscopy revealed multiple curves of semicircle, U or V mimicking the scales of a fish.

This fish scale-like pattern was in favor of a mucosal melanotic macule.

Fish scale-like pattern

Fish scale-like pattern is a new pattern described in mucosal melanotic macules.

Reference: 
Dermoscopy of pigmented lesion on mucocutaneous junction and mucous membrane.
Lin J, Koga H, Takata M, Saida T. 
BJD 161 (6); 1255-61

A yellowish lesion

A 70-year-old woman consulted for this small lesion on her right upper lid.

Dermoscopy revealed:

• a yellow clod pattern
• vessels arranged in a radial arrangement 

typical of a sebaceous hyperplasia

Red lesions

A 62-year-old woman consulted for an acquired red tumor on her left ankle.

Dermoscopy revealed:

• regular red dots
• in a stringlike  distribution

in favor of a clear cell acanthoma

Black lesion.

A 25-year-old woman consulted for a dark pigmented lesion on her abdomen

Dermoscopy revealed:

• asymmetry of form
• a central blotch
• regular pseudopods

Pathology was in favor of melanocytic Spitz nevus

Cheek lesion.

A 55-year-old man consulted for a pigmented lesion on his left cheek

Dermoscopy revealed:

• an irregular broadened network
• rhomboidal structures

Pathology was in favor of a lentigo maligna melanoma in situ.

A small pigmented lesion on a leg

A 29-year-old woman consulted for  a small pigmented lesion on her right leg.

Dermoscopy revealed

• spoke wheel areas

Pathology revealed a superficial basal cell carcinoma 

Regression.

A 21-year-man consulted for this lesion on his arm

Dermoscopy revealed:

• a whitish - pinkish structureless area
• with gray dots

in favor of a regressive lesion.

Pathology was in favor of a fully regressive melanocytic lesion. A fully regressive melanoma cannot be ruled out. 

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.

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.

Back lesion

A 65-year-old man with many pigmented lesions on his back. One of this lesion was atypical.

Dermoscopy revealed:

• multiple colors
• an atypical reticular network
• regression
• a reticular depigmentation  (rectangle)

Pathology revealed a melanoma in situ.

Nodular lesion

A 57-year-old woman consulted for this nodular lesion on her right chest.

Dermoscopy revealed:

• a non pigmented lesion
• remnant of pigmentation (red circles)
• a pink veil
• atypical and polymorphous vessels

Pathology revealed a nodular melanoma (Breslow index 1.6mm)

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.

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.