A solitary skin lesion that caused concern
This middle aged white person presented with a solitary skin lesion on the trunk that they had become anxious about.
There was no clear history of recent change. People worry about skin lesions, and I think this is going to be more the case as time goes on due to publicity. The overall chance of dying from skin cancer is really quite small, in the UK its about 6 deaths a day. But as the lottery poster used to say ‘It could be YOU!’
This lesion doesn’t look very exciting, but let’s get the dermoscope out anyway.
The lesion was slightly too big to photograph the whole field, but it all looked like this. The main colour is pale pink with some clearly visible looped vessels. These are characteristic of seborrhoiec keratoses, also known as basal cell papillomas (BCPs). Looped vessels and hairpin vessels are the same thing, basically a small blood vessel from below going along micro papilla and curving round at the end to come back, making an elongated U shape. They are said to exist in halos (the pale area around them, which I believe to represent a tiny papilla) and are sometimes compared to frogspawn. In this image they make up pretty much the whole lesion, so we can call them a global feature. I can also see a bit of keratin (the whitish circle in the upper half of the image) and a few scattered small blood clots which most likely represent recent minor trauma.
One can confidently say that this is a seborrhoiec keratosis. They have no malignant potential and no treatment is required. These lesions are very often referred as suspected skin cancers, the dermoscope can usually ‘elimiminiate them from our enquiries’.
Please note, seborrhoiec keratoses have a range of appearances. This is one of the typical ways they present, at other times we see more comedo like openings and milia like cysts, or just fissured keratin. I try to post a range of presentations. To get good at this you need to see hundreds if not thousands.