Ugly duckling pigmented lesion proves harmless
A white adult presented with multiple pigmented lesions, one of which in particular caused concern. Several of these lesions fail the ABCD rule.
The outlined lesion was very dark and somewhat irregular. These are features that every advice leaflet will say point to melanoma and they may do. The presence of many similar lesions does not mean this one can’t be a skin cancer.
Dermoscopy however was very reassuring.
This is a typical seborrhoiec keratosis. Note the abundant milia like cysts (white/cream circles) and several comedo like openings. There is a very well defined border from 12 to 6 o’clock where the lesion is best defined, also some hairpin vessels centrally. Variable colour is irrelevant since there are clear positive signs of a seb k.
Reassure and advise.
learning point: check the whole patient carefully. Sometimes a skin cancer will hide among many benign lesions like a pebble hiding on a beach.