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June 1, 2012 / molehunter

ABCD fail pigmented lesion benign on dermoscopy

This pigmented lesion was noted on the leg of an elderly white man who had previously been treated for multiple skin cancers.It is asymmetrical, has an irregular border, mixed colour and is very dark. So it fails the ABCD test which means as far as that goes it is a suspicious pigmented lesion.

ABCD fail pigmented lesion on leg

Dermoscopy however show abundant unequivocal features of a seborrhoiec keratosis, particularly multiple milia like white cysts, comedo like openings and fissures. There are no features of melanocytic lesion or pigmented BCC.

seborhoiec wart with multiple milia like cysts and comedo like openings

VERDICT: innocent.

Even sceptical dermatogists who are slow to encourage GPs to train in dermoscopy will admit that the dermoscope is very useful for screening out benign lesions like this that can look alarming to the naked eye but are unequivocally benign to the trained dermoscopist. If we can safely reassure such patients in the community it should relieve pressure on specialist clinics, saving time and money as well as reducing patient alarm.

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