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March 12, 2011 / molehunter

Black and red= danger

A mole in an adult (dangerous change is very rare under the age of 16) which is recent, changing and which loved ones are worried about should lead to medical advice. When the colours are mixed black and red, RUN. This was a thin melanoma. Thin melanomas are usually curable. Better than 90% of thin melanomas are cured. Don’t let them get thick, don’t wait until they bleed. It’s never wrong to get a funny looking moles checked, I’m not just saying that just  ’cause I’ve got a course to sell, no really-if moles are new, changing, mixed colour, look wrong, get them checked.

This mole looks pretty evil to the naked eye, it is mainly black, irregular and lacks symmetry. The dermoscopy adds a bit of blue veil and also confirms it is melanocytic (reticular network visible at periphery, absence of diagnostic features of haemangioma or seborrhoiec keratosis). However, the dermoscopy was not critical: any clinician ought to strongly suspect this mole from the history and naked eye features. The dermoscope findings strengthen the diagnosis.

The redness (E for Erythema in the ABCDE) is due to the body’s immune system recognising the melanoma cells as something wrong and atacking it. Melanoma is highly immunogenic. If you look at the images of melanoma on the www.dermis.net site (look under superficial spreading melanoma) you will see that at least a quarter of these 160 images of melanoma include some red. Red is a danger sign, visibly or dermoscopically, in a melanocytic lesion. Of course sometimes its due to trauma or infection, traumatised seborrhoeic warts can look scary, I’ll post some images of them later.

PS the white bits are artefacts-bits of lint stuck behind the glass plate of the dermoscope. Annoyingly, the camera autofocus locks on to these so they are in perfect focus but the detail of the lesion is just out. Not every dermoscopic image is of exhibition quality. The only answer is to regularly clean behind the glass plate. To do this with a Dermlite duo type of scope, you need to spin the glass plate off, which can be tricky if it gets stuck down with alcohol gel, a bit of neat liquid alcohol from a Steret helps loosen it up. Do it regularly to get better pictures consistently.

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