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December 15, 2014 / molehunter

funny looking mole on forehead

A s is so often the case, the owner of this ‘mole’ was unsure how long it had been there. but it didn’t look right.

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What can we say about this on naked eye inspection? It is pigmented and irregular. about 5 or 6 mm diameter, and on an older white skin, as we can see from the grey hair. Dermoscope time.

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Now we can see more clearly. There is irregular colour in the form of globules, or clods as the Kittlerian terminology would say. When we see this sort of structure, we ask about 3 characteristics.

size

colour

distribution

Here we find that all 3 characteristics are very variable, amounting to chaos. This is wrong.  In fact using the metaphorical terminology these are ‘blue grey ovoid (egg shaped) nests‘ which are characteristic of pigment containing basal cell cancer. About a quarter of all BCCs contain some pigment. I prefer to use the generic term ‘irregular pigmented structures’. The ‘3 point test’ of Argenziano includes ‘blue white structures’ as one of the dermoscopic  features of skin cancer. In my humble opinion, these different approaches overlap to some extent and it does no harm to pick and mix from them, but in any event these irregular blue white (or blue grey) structures are unnaceptable.

We also note shiny white structures (also known as the chrysalis sign) and sharply focused tapering blood vessels. The latter in particular point to BCC, which was the diagnosis. Many specialists think that all suspected pigmented BCCs should be excised urgently as they might be melanomas. I have no problem with this if resources permit but the arrangement of pigment here pointed correctly to a BCC.

Hope that wasn’t too confusing! There are a lot of different ways to look at dermoscopy. Bottom line, this lesion is new, changing, looks wrong and is in a sun exposed location in an older white person.

PS a basal cell cancer is not a ‘mole’ technically, but people don’t always use the correct technical language.

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