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

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

Mole with an eccentric pigmentation

A 40-year-old woman consulted for a mole with an eccentric hyper pigmentation.

Dermoscopy revealed:

• an atypical reticular network
• an eccentric dark reticular network
• irregular brown dots

Lesion was excised and pathology revealed a melanoma in situ.

Atypical (dysplastic) nevi

A 19-year-old man consulted for multiple atypical (dysplastic nevi or Clark nevi) on her trunk. Three of them were clustered on her back. They featured three different dermoscopic patterns:

1-reticulo-globular pattern with eccentric hyperpigmentation

2 - multicomponent pattern (globular, reticular and homogeneous patterns)

3- reticular pattern with central hypopigmentation

Atypical (dysplastic) nevus with eccentric hyperpigmentation

Atypical nevus with eccentric hyperpigmentation is an atypical nevus of the utmost importance because its differential diagnoses are melanoma in situ and early invasive melanoma. In our case, the hyperpigmentation corresponded to a darker reticular network. In certain cases, the eccentric hyperpigmentation is a blotch.
This lesion was removed and the diagnosis of benign atypical nevus confirmed by the pathologist.

Eccentric pigmentation

This lesion presented an asymmetric reticular network with an eccentric pigmentation, globules, and signs of regression with blue-gray dots (peppering).
The lesion was excised and pathology revealed a junctional melanocytic nevus

Eccentric hyperpigmented area

This pigmented lesion was asymetrically pigmented. Dermoscopy revealed a globular pattern in the center and a reticular pattern at the periphery with an eccentric hyperpigmented area (circle)
There were no dermoscopic criteria for a melanoma. We have to be very careful with this dermoscopic feature of eccentric hyperpigmented area because it is observed in atypical nevus but also in melanoma in situ and early invasive melanoma. Two attitudes could have been proposed: 3-month dermoscopic follow-up or immediate excision. In our case we choose to cut it off and pathology revealed a benign compound nevus (dermal and junctional