This elderly lady had a lesion on the right shin. She felt it had been present for quite a long time and was uncertain as to whether or not it had changed. What do you make of the dermoscopic features and how would you manage this case?
Dermoscopy - Introduction, Terminology and Structures
A document to help you understand the dermoscopic descriptions used in this blog.
Dermoscopy Algorithm
To help you work through dermoscopic cases.
Are we seeing grouped smooth clods here, in which case we should consider a probable melanocytic lesion? If so we may be concerned.
Just occasionally a lesion has grouped brown clods that are non-melanocytic. The more reassuring features to this case include an even brown colour and a well-demarcated border (black arrows) more in keeping with a solar lentigo. The structures circled appear to be starting to stretch out and as such could represent very early pigment bands, structures we see in thin seborrhoeic keratoses. Some solar lentigines will develop features of a seborrhoeic keratosis.
I was following the patient up for another matter so simply observed this lesion, which was flat - three months later the lesion was unchanged and the diagnosis in keeping with a solar lentigo/thin seborrhoeic keratosis.
It would have been totally reasonable to refer this lady urgently as a 2-week wait.
Copied with kind permission from South Tees Foundation Trust.
