Melanoma ?

A 52-year-old woman consulted for an atypical pigmented lesion on her right thigh.

Dermoscopy revealed:

• asymmetry
• eccentric pigmentation
• atypical reticular network
• depigmentation
• pink/red area

Clinical and dermoscopic images were in favor of a melanoma.

Lesion was excised and pathology revealed a dermatofibroma.

This case is interesting to show how a dermatofibroma may be atypical:

• clinical examination: no induration at palpation and asymmetry of colours
• dermoscopic features

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.

Halo nevus

A 16-year-old boy underwent a yearly mole check-up. One year later, one of his nevi presented a peripheral depigmentation in favor of halo nevus.



The difference between the two dermoscopic images at a one year interval was very marked:

• depigmentation of the surrounding skin
• enlightening of the global pattern and rarefaction of the globules
  

In this case occuring in a teen, there were no atypical dermoscopic features in favor of a melanoma and another appointment was scheduled one year later.


Halo nevus is a benign lesion and no treatment is required. It is a frequent phenomena during childhood. Despite benign features, the presence of a new halo lesion in an adult has to be examined with a high index of suspcion of melanoma. If a halo nevus is showing atypical dermoscopic features, an excision has to be scheduled.

Melanocytic nevus

A 28-year-old woman consulted for an enlarging scapular nevus on her lefts scapular area.
The presence of an irregular depigmentation and blue-gray dots (circle) in favor of a regression lead to excise it. Pathology revealed a benign dermal melanocytic nevus.

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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Blue nevus

Some blue nevi can present areas of depigmentation.

Melanoma with regression

A 62-year-old patient with a superficial spreading melanoma on his right shoulder.

Dermoscopy (x20) revealed white areas (scar-like depigmentation) and delicate peppering.

Other cases of melanoma
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