Irregular pigmented network with globules
I don’t have a plain view of this lesion from my archives but it is worth looking at as an example of irregular pigmented network with irregular globules and blue grey veil.
We know this is melanocytic because there is clearly defined reticular network. As discussed, this is a visual artefact where lines of pigment appear to surround holes (or cells) which are the dermal papillae of the rete ridges seen from above.
Since it is melanocytic, we may ask ‘could it be a melanoma?’ or to ask the same question in a different way, ‘Can I be positively sure this lesion is benign?’. In answer to the last question, no of course not! It is obviously wrong, but can we specify exactly why?
Let us apply the SCOPE test
Symmetry-not at all
COunt the colours-I can see black, brown (2 shades irregularly distributed) and blue-grey. 3 colours as a rule is one too many.
Patterns-I can see regular network, irregular network, eccentric black blotch, blue-grey veil and irregular globules. 5 patterns. Not good. NB look carefully at the dots and globules-they are highly irregular is size and distribution, which is a strong pointer to melanoma. They represent nests of multiplying abnormal melanocytes.
Edge-very irregular as we trace our way from 12 o’clock round the edge.
Histology was of course a melanoma, thankfully a thin one with a great chance of cure. There is a lot on the web about what a deadly disease melanoma can be, and yes that is what motivates me to freely make this learning resource available, but the great reward is that melanoma is a very curable cancer when caught early, which dermoscopy with training and experience can assist with.