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April 26, 2015 / molehunter

Asymmetric dots and globules in a thin melanoma

This lesion presented as an ugly duckling, a mole that stood out as different from any of the person’s other moles. The ‘Ugly Duckling’ sign is probably the single most useful pointer to a skin cancer, although its not very specific. Anyone with 2 or more moles will have a largest mole, a darkest mole, a least symmetrical mole, etc. The single outlier may well be harmless, but it deserves a second look.

16 A

Definitely much bigger than any of the other moles on this person’s back. Let’s take a closer look16 B

on the good old ABCD rule (Asymmetry, Border, Colours, Diameter) this is a fail, but not a massive fail.Cutting it out will make a fairly big scar so we need to be sure. Apply the dermoscope.

16 Ccase 16 (3)

The asymmetry is seen more clearly. Applying the 2 step rule-it it melanocytic? Yes, because we can see reticular network and brown dots, also there are no features supporting the diagnosis of a non melanocytic lesion. So, step 2, if melanocytic, could it be  melanoma? Evidently yes, due to the marked asymmetry of the dots and globules we see from 3 to 6 o’clock. In the close up we can see it is a dotted network, very suspicious. remember that dots and globules in melanocytic lesions indicate new growth-OK if perfectly symmetrical in a young person, not otherwise.

NB there is arguably a hint of a reverse network in the paler areas, we can argue about this but it makes no difference to the verdict and sentence.

Histology showed a very thin melanoma, so we can be close to 100% certain of a cure. That’s what I like about dermoscopy.

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