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.

A black tumor on a thigh.

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

Scalp lesion

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)

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.

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

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.

melanoma

A 82-year-old woman consulted for this dark pigmented lesion on her left arm. Clinically a melanoma was suspected.

Dermoscopy revealed:

• a multi-coloured pattern
• a blue white veil
• blue gray dots
• whitish scar-like depigmentation
• polymorphous vessels including linear irregular vessels

Superficial spreading melanoma

A 66-year-old man consulted for a pigmented lesion on his left scapular area.

Dermoscopy revealed a multi-component pattern, asymmetry, and multiple colours (tan, dark brown, black, blue gray, white).
Other signs were an atypical reticular pattern (irregular holes and thick lines) with a sharp demarcation, a blue-white veil and atypical vessels (irregular linear vessels), a central ulceration (crust). Dots were irregularly distributed.

All these dermoscopic signs were in favor of a superficial spreading melanoma.

Superficial spreading melanoma

A 50-year-old man presented an irregularly pigmented lesion his back. Dermoscopy revealed an asymetric pigmentation, multiple colors, streaks (red circle), and a delicate blue white veil in favor of a superficial spreading melanoma.
The lesion was removed with a 2 mm margin and histology confirmed the diagnosis. The Breslow index was measured 0.63 mm. A re-excision was performed with a 1 cm margin. No mestastases were detected.



Other cases of melanoma
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Invasive melanoma

A 62-year-old man consulted for this multicolored tumor on his scapular area. This lesion was clinically in favor of an advanced invasive melanoma (nodular melanoma).



Asymmetrical pigmentation pattern, multiple colours , atypical vessels, atypical reticular pattern, blue-white veil, and ulceration were found in this case of invasive melanoma, Breslow thickness 9mm





Other cases of melanoma
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Blue-white veil

This lesion was a superficial spreading melanoma, Breslow thickness 5.7mm.
A blue-white veil was clearly evident on this thick melanoma.



Other cases of melanoma
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Superficial spreading melanoma

The clinical aspect of this pigmented lesion was in favor of a superficial spreading melanoma.
Dermoscopy showed multiple colors (tan, dark brown, black, gray, blue), areas of regression (scar-like depigmentation), a blue white veil.
The lesion was excised and pathology revealed a superficial spreading melanoma, Breslow thickness 0.56mm.




Other cases of melanoma
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Superficial spreading melanoma

A 47-year-old woman developed an enlarging dark brown tumor on her right foot for several years. Dermoscopy revealed a multicomponent pattern with an atypical reticular network, streaks and a blue-white veil. Excision revealed a superficial spreading melanoma with a Breslow index measured at 0.7 mm and a Clark's level II.



Other cases of melanoma
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Regression structures

Asymmetrical multicoloured pattern with regression structures:
- blue-white veil
- scar-like depigmentation and blue-gray dots
The diagnosis was a superficial spreading melanoma, Breslow thickness 0.55mm.






Other cases of melanoma
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Melanoma of the ear

Dermoscopy revealed an atypical pigment network (light brown, dark brown and black) with a broadened network and a blue white veil. Pathology revealed a superficial spreading melanoma with a Breslow index measured 0.55mm

Other cases of melanoma
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