Suspicious ‘mole’ on leg

When people have already had one or more skin cancers, the prospects of getting further skin tumours increases, all the more so with advancing age. When I see patients under the age of around thirty years, I can be almost certain before I see them that they won’t have a skin cancer. The average age for a melanoma diagnosis is around 65.

This older white man was referred with a suspected melanoma on the leg.

pigmented lesion on older white leg.

i am always banging on about new or changing solitary pigmented lesions on older white legs, and there are a dozen examples of melanomas presenting like this in my new e-book, Skin Cancer Diagnosis Made Easy. However, not all such lesions will be malignant. Benign skin lesions vastly outnumber skin cancers at all ages, and the skilful diagnostician learns first of all to confidently recognise the harmless in order to reassure and advise.

This lesion is somewhat angular, although the colour is fairly even. to the touch, it was slightly elevated but flat topped.

Solar lentigo.

Dermoscopy shows a very even pattern of mostly reticular lines. if you study the border, it is somewhat wavy with undulations, but is equally well defined all round. this is what we call a lentigo-like border, and this is a typical solar lentigo. The darker clods near the middle are of o consequence.

Solar lentigines (plural of lentigo) are very common in older white sun exposed skin, and can usually be distinguished from melanomas by having an even border and a regular pattern of fine lines, reticular lines, or dots. these may be mixed up a bit, but don’t fuss about trivial degrees of asymmetry. This lesion is essentially only one colour, only one pattern, therefore no chaos. There are no melanoma clues and the patient can be safely reassured and advised.

It is good practice, especially while learning, to place the dermatoscope on hundreds and hundreds of pigmented lesions about which there is no clinical suspicion. This way, the examiner is training their brain to recognise the range of variation within the ‘normal’ envelope.