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October 10, 2012 / molehunter

Pigmented lesion lower leg

This lesion had been present for many years without changing.

5mm diameter blue papule lower leg.

A close up confirms the smooth border and blue colour.

Slightly irregular colour, but all blue, nearly a perfect circle and no notches or projections of the border.

Dermoscopy emphasises the less than perfect regularity of the colour, but there is still no colour other than blue and no feature other than amorphous.

Harmless blue naevus. Do not be alarmed by the mild irregularity of the blue and blue/white here.

The beginner at dermoscopy may well cry ‘blue white veil!’ here, but not so. A blue white veil has to be seen in context. In a small, stable (i.e. not growing or changing) lesion like this where there are no other features, it denotes a blue naevus. If you found these colours as part of an irregular pigmented naevus that was changing, you should be very concerned.

Malignant blue naevi do occur, but are rare. The only one I have ever seen (I don’t have a photo) was currently changing, over 1cm diameter, and irregular.

The patient was reassured and advised that as long as the mole did not change significantly there was no need to remove it.

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