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September 15, 2014 / molehunter

Another pigmented BCC

New lesion, elderly white patient’s face. First noticed 4 months ago, seems to be growing slowly.

one more pigmented BCC  (2)

The lesion is roughly oval in shape, a papule (elevated but under 1cm diameter) and the lower third is distinctly darker than the main body of the tumour, which is pink and somewhat translucent. Could it be a melanoma?


Dermoscopy shows a pink background, classic arborising blood vessels (click on the relevant category on the right to see more examples of these vessels in this blog) and irregular pigmented structures. This is highly indicative of a basal cell cancer.

Study the vessels. They taper, curve, branch, cross the centre of the lesion, and remain sharply focused. These characteristics are all typical of BCC. The pigmented structures will make the inexperienced doctor think of a melanoma-no harm done. However in the context of the pink background and typical vessels, the betting must be on a BCC. There is no pseudonetwork, and the structure of the pigmented features are typical of BCC. Google ‘dermoscopy pigmented basal cell cancer’ to view many of these lesions and you will see what I mean.

Some dermatologists feel that all suspected pigmented BCCs should be excised urgently as per suspected melanomas. I have no problem with that, in fact would like to see all suspect skin lesions removed withing 7-10 days if resources allowed, but this is a pigmented BCC as histology will confirm in due course. (Confirmed)



One Comment

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  1. Joanne Smith / Sep 27 2014 11:48 pm

    Just discovered this site and finding it very useful as it answers the obvious beginners’ questions about confusing appearances. The repetition is very helpful at reinforcing points..

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