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May 24, 2012 / molehunter

yet another ugly duckling

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On a mildy to moderately sun damaged back, one pigmented lesion is more obvious than any other. It needs to be evaluated with the dermoscope.

The close up is not very impressive, just a bit of colour variation within the lesion, although it does show the sun damage (hundreds of little brown marks, solar lentigos or ‘sun freckles’ which are an indication of past sun damage. This is an indicator of increased risk of skin cancer.

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Dermoscopy is decisive

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The reticular network shows this must be a melanocytic lesion. It is highly irregular in places (study the dark lines as they vry in breadth and depth of colour-this is an abnormal network). On the lower and leftward part of the lesion, the abnormal network is coalescing into an asymmetrical black blotch with a blue-white veil (looks purple in this projection).

IMPRESSION melanoma

ACTION refer urgently for excision

OUTCOME histology as expected confirmed a thin, so good prognosis, melanoma. Another case where a relatively innocuous looking pigmented lesion on dermoscopy has worrying features enabling early diagnosis and treatment.

REFLECTION melanomas detected and removed at this stage will almost always NOT have spread so the person will be cured. Despite improvements in melanoma oncology, the best chance of avoiding a bad outcome (i.e. death) is early detection and surgery. Melanomas removed when they are less than 1mm in depth are associated with a better than 95% propect of the person still being alive in 5 years.(*) Melanomas that are not reported until they have become a bleeding lump are very likely to have already spread. Skilled dermoscopy can help, but ultimately the important thing is that people are aware of the need to get a funny looking or changing mole checked and NOT wait until it starts bleeding. It will often be too late by then.

(*) NB that is how researchers measure survival, the percentage still with us after 5 years from an event e.g. melanoma diagnosis. A 95% 5 year survival does not mean that 5% died of their melanoma, its a standard measure of ‘all cause’ mortality and includes deaths from other causes, such as heart disease or accidents etc. So a 95% 5 year survival after diagnosis of a thin melanoma is really very good. Given that melanoma is a potentially fatal cancer.

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