A pebble hidden on a beach
Like many older persons, this gentleman had a large number of benign pigmented lesions on his back. Most are seborrhoeic warts, several are marked with purple marker pen to indicate they have been injected with local anaesthetic prior to shave excision. There was something different about one lesion. Can you spot which one? It is circled in the next image. The patient was unaware of it.
here’s a close up
The dermoscopy reveals a bizarre blood vessel pattern -mixture of arborising and hairpin-which together with the pink pearliness strongly pointed to a BCC, which was confirmed on histology.
The no-touch dermoscope is very helpful for scanning large numbers of lesions, looking for the odd one out which can then be examined more fully with the glass plate ‘scope. Beware of the hidden skin cancer on a skin which is covered with benign lesions, it won’t always be a relatively harmless little BCC, sometimes it will be a melanoma, hiding like a pebble on a beach.