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November 18, 2014 / molehunter

A growing solitary pink nodule on chest

Skin lesion recognition teachers are all agreed that the solitary growing pink lesion on older white sun exposed skin is one to watch out for. Here is a lesion answering that description.

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Its about 1cm diameter give or take a few mm. Not a lot to see.

The differential diagnosis would include (in no particular order of likelihood) cutaneous metastasis from known or unknown primary cancer elsewhere, basal cell cancer, squamous cell cancer, non pigmented melanoma, Merkel cell cancer, or maybe  even an epidermoid cyst or other benign lesion that has become inflammed. It could even be an inflammatory manifestation of a skin rash rather than a tumour.

Can dermoscopy help? Let’s see. As ever, click on the image to see a larger version.

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We see pink background with arborising vessels as a global feature. There are no other features.

This is a typical nodular basal cell carcinoma, no debate. The important differential diagnoses of amelanotic melanoma, Merkel cell cancer and cutaneous metastasis are unlikely as these lesions typically show polymorphous vessels. I’ll post some examples of these later.

Arborising vessels are so called as they resemble the bare branches of an oak tree in winter. They taper, curve, branch and cross the centre of the lesion. They remain very well focused thoughout their length due to their being on the surface of the lesion. You do see vessels like this in scars and some other skin lesions, but taken with the history of slow but steady growth, pink background and lack of other features, we can be confident this is a BCC.

Other dermoscopic features of BCC are micro ulcers and irregular pigmented structures. See other examples on this blog and the linked dermoscopy education resources on the right of this page.

A very simple case, but no apologies for repetition-we gain experience through seeing many cases.

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One Comment

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  1. Brian / Jul 8 2017 1:26 pm

    Thank you for taking the effort to blog this. It helps me understand what my problem is.

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