Pigmented basal cell cancer
Presenting with a non-healing scab over several weeks or months, a typical BCC story.
The dermoscopic view reveals many typical arborising telangiectatic blood vessels over a pigmented pearly base with a large ulcer (visible on plain view) and some irregular pigmented structures in the bottom right. Plenty enough evidence to confirm a basal cell cancer, as proven on histology. Around 15-20% of BCCs have some pigment, a few are sufficiently pigmented to attract the epithet ‘pigmented BCC’. It is excusable to confuse these with melanomas, although the experienced dermoscopist will usually be able to tell. There is a case for fast tracking such lesions ‘just in case’ and I have no argument with that. But this was obviously a BCC on dermoscopy.