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April 22, 2016 / molehunter

Nasty looking mole on older person’s back

This mole which had come up new on an older white person’s back over the last year looks really nasty. That’s because its a malignant melanoma.

case 20 A

I mean, just take one look at it-multiple colors, irregular edge, no symmetry, and a raised part with a scab on the right. Dermoscopy is superfluous, but let’s try it anyway.

case 20 (1)

Not a very good picture, one of my first from over 10 years ago, but we can see some additional detail. From 7 to 10 o’clock there are lines pointing away from the body of the lesion-this is variously described as radial streaming, streaks, branched streaks or peripheral lines radial. I think streaks is a good term due to its simplicity, but any of the other dermoscopic terms will do. There are also irregular globules. Arguably also pseudopods. A pseudopod is basically a streak with a blob on the outer end. I don’t make a big fuss about the distinction between these 2 entities, but pseudopods are said to be very specific for melanoma when you see them.

This was a nodular ulcerated melanoma, a dangerous lesion. The overall survival rate for all melanoma patients in developed countries is now better than 80%, but for this lesion the odds would be somewhat poorer as it is thicker. We really need to get better at recognising these and cutting them out when they are thinner.Better training in early diagnosis for Primary Care health workers, doctors and nurses, should help.

 

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