<p>A 42 year old man presented with a lesion on his back. This appeared approximately 3 months earlier, but the story was that it was now 4 times smaller that it had been. OE there was a firm nodule. What is your management?</p>
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.
<p>Clinically this is an EFG (Elevated, Firm, Growing) lesion and so needs to be treated with suspicion. </p>
<p>Dermoscopically the lesion is generally featureless, although there is a hint of a network (black circles). The central area shows atypical vessels (arrow), which is surrounded by white structureless areas. </p>
<p>Essentially this is an ugly duckling that cannot be positively identified from clinical grounds alone. Although a pyogenic granuloma is possible, the lesion did not bleed as much as one would expect for a PG, and the dermoscopic features were more concerning. </p>
<p>Such lesions need urgent attention and excision. Histology showed a melanoma with a Breslow thickness of 1mm.</p>
<p>The most important aspect of a hypomelanotic lesion is whether it is an ugly duckling or does the patient have similar lesions? If it is an ugly duckling then urgent attention is required.</p>
<p>In terms of the history of this getting smaller, while it is important to take a good history that may give important clues to the diagnosis, one should not let the history override a clinical impression.</p>
<p>Copied with kind permission from South Tees Foundation Trust.</p>
