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May 7, 2013 / molehunter

New pigmented lesion on middle aged female’s leg. No other relevant history.

 

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Let’s take a closer look.

 

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Looks quite red on the macro view. That’s OK if its a haemangioma, not otherwise. Time to get the dermoscope out.

 

Dermoscopy shows blue-white veil, irregular globules and pseudolacunae

Dermoscopy shows blue-white veil, irregular globules and pseudolacunae

Several of the learners on my course wondered about this being a haemangioma. I can see their point. However the presence of GLOBULES points to a melanocytic lesion.

 

The globules are irregular in size, distribution and to a lesser extent colour. At the centre of the lesion is an out of focus blue and white haze. This is a blue-white (also called blue-grey) veil and is highly sensitive for melanoma. You can see this sort of colour in seborrhoiec warts and haemangiomas, but this lesion has GLOBULES (excuse capitalisation, but this is important). That means it’s melanocytic, therefore if not benign, melanoma.

 

Some blobs of colour can be seen with a vague whitish lacy network between them, particularly at around 9 o’clock. These arguably look a bit like the lacunae of blood you see in a haemangioma. However, the globules rule out that diagnosis . These shadowy mauvish structures can be fairly labelled pseudolacunae. Get a look at lots of haemangiomas to see the difference. I have posted a few haemangiomas, but don’t limit your education to this site, Google Images on dermoscopy haemangiomas and study as many as you can.

 

Histopathology confirmed a 2mm melanoma.

 

I was certain this was a melanoma clinically but concede that features arguably suggestive of haemangioma exist. The brown globules however were diagnostically decisive. A challenging lesion but there was enough information, especially considering the history and solitary nature of the lesion, for an unequivocal decision to excise.

 

 

 

 

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One Comment

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  1. Kash Bhatti / May 8 2013 11:46 pm

    Wow. On first glimpse, such an innocuous-looking lesion. I wonder how this was referred to you – as a fast track, urgent or routine, and how long the GP had watched it? I’m not sure, given only a new/recent lesion, whether I would have referred immediately (without the aid of a dermatoscope) or as a fast-track. A penny for your thoughts?

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