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May 3, 2017 / molehunter

Subtle melanoma

This pigmented lesion on a middle aged woman’s upper arm had been present for several years. There was some doubt as to whether or not it had changed recently. It was flat to palpation and mildly asymmetrical in shape, outline and colour as the image shows.

thin melanoma very subtle (4) - Copy

A full skin check showed it was the biggest mole on her whole body, the ‘ugly duckling‘ Dermoscopy was performed.

thin melanoma very subtle (2)

This is not a very dramatic image, no colour but brown but 2 very distinct patterns. The upper half, taking a line from about 2 o’clock to 8 o’clock, was a mix of reticular and featureless (not photographed very well) but the lower half is made up of globules (=‘clods’ in the modern descriptive terminology). They are of roughly similar size and colour, but the distribution is highly asymmetrical. On balance, the mole was removed for histology.

It proved to be a thin melanoma, 0.5mm Breslow thickness with zero mitoses so almost certainly cured. 

Learning point: as ever, take a holistic view, and err on the side of caution. Some of the melanoma images I post here are so obviously bizarre that a bright child of  6 or 7 could see they needed cutting out, but not always. The goal is to catch them early. As the melanoma develops, it becomes easier to diagnose but harder to cure.

Also, never forget the ugly duckling sign. This catches more melanomas than any other single factor. The mole that looks different, in any way, from all your other moles deserves attention, especially if it is new or changing.

PS note also the many freckles (solar lentigines/lentigos) on the person’s upper back. These are a sure sign of past sun damage, therefore the risk of a melanoma is somewhat higher than in a person of the same age and skin colour without a load of freckles.

 

 

 

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