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.

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. 

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.

A 32-year-old man consulted for this enlarging pigmented lesion.

Clinical presentation: multiple couleurs, asymmetry

Dermoscopy revealed:

• multiple colors
• irregular dots
• pink structureless area
• irregular blotch
• regression

This lesion was easily diagnosed superficial spreading melanoma.

Pathology revealed a superficial spreading melanoma with a Breslow index at 0.5mm

Regression

A 48-year-old woman presented this pigmented lesion on her back. 

 1: clinical picture

 2: dermoscopic picture

3: dermoscopic picture

  4:  dermoscopic picture

Dermoscopy revealed:

• regression areas with some depigmentation (green arrows and ovoid area)
• blue gray structures (blue arrows) and blue gray dots (peppering)
• linear irregular vessels (black arrows)

Lesion was excised and pathology revealed a regressive superficial spreading melanoma with Breslow index at  0,39 mm

A slowly enlarging pigmented lesion

A 32-year-old woman consulted for a pigmented lesion on her left arm. This lesion was slowly enlarging for 3 years.

 Dermoscopy revealed:

• an atypical reticular pattern with a total disorganization
• multiple colors
• signs of regression

 Two punch biopsies were performed.
Pathology was in favor of a melanoma in situ.
Lesion was excised with a 0.5 margin.

Pectoral lesion

A 52-year-old man presented this pectoral lesion. No clinical history was available.

Dermoscopy revealed:

• multiple colours
• a multi-component pattern
• an atypical reticular pattern
• some pseudopods 
• irregular blotches
• regression areas

Pathology confirmed the diagnosis of superficial spreading melanoma.

Regression

A 61-year-old man consulted for a pigmented lesion on his back.

Clinically this lesion was asymmetrical with 2 colours: pink and black.

Dermoscopy revealed: regression signs with a pink area, blue gray dots with a peppering aspect.

Pathology report: fibrosis and inflammation, hypermelanosis. Melanophages developed on a 1 mm depth. Immunochemistry: anti-human A negative.

In conclusion, this lesion was a fully regressive melanoma.

We recommend to read this article:

Dermoscopy of fully regressive melanoma. L. Thomas and al.

The British Journal of Dermatology. 2008;158(6):1224-1229

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.

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

Meyerson's nevus

A 50-year-old man consulted for a pruritic pigmented lesion on his abdomen which rapidly changed with a peripheral erythema in favor of a Meyerson's nevus.

1a - Clinical view: eczematous halo around a pigmented nevus (before treatment)

Dermoscopy revealed a peripheral erythema circumsbring a pigmented lesion with a negative pigment network and regression areas.

1b - Dermoscopy: negative pigment network.

A short corticosteroid topical treatment was prescribed and after 10 days, the eczematous halo was less important. Dermoscopy revealed blue-gray areas in favour of regression.

2a -Clinical view after a corticosteroid topical treatment (10 days)

2b - Dermoscopic view: after a corticosteroid topical treatment.
Globular pattern with some blue-gray areas in favor of regression.

Because of these signs of regression, the lesion was excised. Pathology was in favour of a benign Meyerson's 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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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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