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June 24, 2012 / molehunter

A nondescript pink papule

This 4/5 mm pink papule didn’t look much to the naked eye. Can you tell what it is yet?

a nondescript 4-5mm pink papule on white skin.

Dermoscopy reveals a full house of the 4 classical features of a basal cell cancer (BCC). Click on the image to enlarge.

dermoscopy of a BCC

On examination of this dermoscopic image we can see

-pink background

-micro ulcer (orangey/red area centrally)

-arborising vessels

-irregular pigmented structures ( blue/grey ovoid nest in from 2 o’clock plus some irregular brown and greyish dots flecks above the central micro ulcer)

A small BCC like this is not a present danger, but treating it at this size will be cheaper, easier, less painful and give a smaller scar than if it was left to get bigger. This matters much more if they are on the face, as so many are. BCCs near the eye or nose can be trickier to remove adequately without leaving a big scar. Catching them by alertness and dermoscopy when they are only 4 or 5 millimetres makes surgery MUCH easier with smaller scars for the patient. Dermoscopy can help diagnose them smaller, any postman or shopkeeper can diagnose a great big bleeding lump. Although BCCs never spread to other parts of the body and are always curable, once they have begun they will never stop growing.

Look at the post with 4 big lcerated BCCs, that’s what this little spot will turn into if we let it. The dermoscope allows us to pick them up smaller.

PS having studied the dermoscopic image, go back to the plain view. Can you now see the deep blue dot?

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