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.

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

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.

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. 

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

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.

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.

Melanoma in situ

A 65-year-old woman presented a changing of color and size of one of her nevi. This nevus was localized on her back.

Dermoscopy revealed a central part with aggregated globules and an atypical and asymmetric reticular pattern.

This lesion was excised and pathology revealed a melanoma in situ in association with a dermal nevus.

Asymmetry is one of the most important parameters of melanomas in situ.

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.

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

Early superficial spreading melanoma

A 37-year-old man consulted for an enlarging pigmented lesion on his abdomen.


Dermoscopy revealed an atypical pattern with an asymmetry, homogeneous area, irregular dots and globules, and irregular branched streaks.


The lesion was excised and pathology revealed a superficial spreading melanoma with a Breslow index non measurable.

Other cases of melanoma
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Lentigo maligna simulating an actinic lentigo

A 72-year-old woman consulted for a pigmented lesion on her right forearm.


Dermoscopy revealed an asymmetric pigmented lesion with different shades of brown colour, fingerprint-like structures and moth-eaten borders. These dermoscopic signs are observed in actinic lentigos or flat seborrheic keratoses.
However, a biopsy revealed a lentigo maligna.
The lesion was excised and pathology confirmed the diagnosis of lentigo maligna melanoma in situ.


Facial lentigo maligna melanoma (LMM) typically features asymmetric follicular openings, annular-granular pattern, rhomboïdal structures and homogenous areas.

In our case of extra-facial LMM, the presentation was different and was masquerading as an actinic lentigo.

Extra-facial LMMs comprise 17,5% of LMMs. Extra-facial LMMs of men are predominantly localized on the trunk while the most frequent localization in women are on limbs. Extra-facial LMMs are thinner than facial LMMs at presentation and affect younger group of patients.

See the literature: Cox, Aitchison & Mackie. Extrafacial lentigo maligna melanoma: analysis of 71 cases and comparison with lentigo maligna melanoma of the head and neck. Brit Journal Dermatol 1998; 139: 439-43

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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Atypical (dysplastic) nevus

A 68-year-old woman consulted for this pigmented lesion on her back.
Dermoscopy revealed an asymmetric lesion with an atypical reticular and homogenous pattern , a few subtle blue-white structures (circle) and brown dots (arrow)
The lesion was excised and pathology revealed an atypical (dysplastic) compound type.

Traumatized nevus

A 52-year-old woman used to be heavily sun-exposed during her holidays. Her husband noticed that a mole on her back was changing. Dermoscopically the lesion shows asymmetric colors and structures, a reticular and homogenous pattern and central area of hypopigmentation. Main hypotheses were an atypical (dysplastic) nevus with central hypopigmentation or a superficial spreading melanoma. The lesion was excised. Pathology revealed a traumatized benign junctionnal naevus. The patient did not remind any traumatism on this lesion. Melanocytic nevi can have atypical clinical and dermoscopic presentations in case of traumatism. This traumatism is sometimes not mentionned when taking the history

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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