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August 6, 2013 / molehunter

another sheep in wolf’s clothing

This case makes exactly the same points as the last one which I posted a few minutes ago.

sheep in wolfs clothing (1)

A lesion was presented as it was a stand out lesion (‘ugly duckling’) that looked quite alarming and had recently got bigger and/or darker and elevated. The patient had every reason to seek advice about a pigmented lesion like this. For all he knew it could be a nodular melanoma.

As with the last case, the dermoscope reveals features which can be confidently used to support a benign diagnosis, seborrhoiec keratosis. See commentary on the last case, its exactly the same situation.

This situation is incredibly common so I make no apology for posting multiple examples of the same clinical situation. In the right hands, and with training and experience, a dermoscope could quite literally save a local health economy its own weight in gold over a few years by screening out straightforward cases like this in Primary Care.

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For beginners, here is a copy of the dermoscopic image with downward pointing arrows showing the comedo like openings (also known as keratin pits) and horizontal arrows indicating milia like cysts.

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