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November 14, 2014 / molehunter

Subtle but complex changes in a melanoma

This pigmented lesion looks relatively innocuous to the naked eye, but came to attention as it had grown recently.

It was around 9mm diameter.

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How many colours can you see? How does this do with the ABCD rule?  I would say that symmetry isn’t too bad, 2 maybe three colours at a stretch, and border reasonably even except maybe at 6 and 11 o’clock. Lets take a look at the sub macroscopic structures with the dermoscope. As ever, click on the image to blow it up for a better view.

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OK, how many colours now? A few more, including blue grey that I couldn’t see on plain view.

How about structures?

I can see reverse/inverse pigment network, irregular groups of dots (groups at 2, 7, 9 and 11 o’clock), blue grey veil and overall chaos. There are some irregular globules too, I can see a big group in the left upper quadrant and a few more scattered around.

Has to be a melanoma, and of course it was. Thankfully thin so hopefully curable- DON’T WAIT TIL THEY GET BIG AND BLACK AND BLEEDING!!!!!! Compare and contrast this with some of the benign naevi I have posted here which are not perfectly symmetrical but compared to this are very banal indeed! There is no substitute for dermoscoping hundreds of harmless pigmented lesions about which there is no clinical suspicion, then the odd one stands out.

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One Comment

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  1. Family Medicine News / Nov 14 2014 8:56 pm

    Great case. Beautiful example of a negative network!

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