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July 8, 2012 / molehunter

Suspicious pigmented lesion with radial streaming and regression

This pigmented lesion about 1cm diameter is dark and iregular, certainly calling for closer examination. Let’s get the dermoscope onto it.

Dermoscopy reveals additional features of interest.

Dermoscopy reveals additional features

Question one: is this lesion melanocytic? If we look carefully, there is delicate but clear reticular pigment network throughout the bottom left hand quarter of the lesion. Also, features of a non melanocytic lesion such as haemangioma, seborrhoiec wart, BCC, or dermatofibroma are definitely absent. Therefore yes it is clearly melanocytic. Having established this, if it is not benign, it must be a melanoma (or at the very least a severely dyslastic naevus). PS the reticular network is quite irregular, in particular there is a grey area at about 6 o’clock, abutting the pale and grey circle (see below). Grey is never a good colour to see in dermoscopy.

It is highly irregular overall. The upper part of the lesion shows radial streaming of pigment. At the base of this there is a reddish blush: ‘red colour beware’ as professor Peter Soyer says. There are 2 large pale areas with iregular grey ‘brush strokes ‘ (not an official term) within the mole, a large one on the right of centre, another circular area of white with grey low down. These are highlighted in the third image, see below. These are regression structures, very suspicious when making up more than 10% of a melanocytic lesion. You can see regression in benign lesions, it can obscure the diagnosis. Professor Argenziano when I last heard him lecture said regressing lesions should normally be excised. There is anyway chaos and irregularity enough here to make excision mandatory.

Melanoma was confirmed, a thin lesion therefore hopefully curable. At least 95% of people whose melanomas are excised when thinner than 1mm will be cured, but survival rates fall steadily as melanoma thickness increases. That’s why it is so vitally important to build quick and easy access to skilled diagnosis for people with abnormal looking skin lesions, however our health care systems are configured.

The ovalled areas highlight pale patches with grey blobs and squiggles within the lesion, highly suggestive of regression.

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