<p>What is your provisional diagnosis of this pigmented lesion given both the clinical and dermoscopic appearance?</p>
<p>Given the number of peripheral clods we can say that the lesion is melanocytic. The position of the clods also suggest that the lesion is growing.</p>
<p>The question is, is this growing in healthy fashion or could this be malignant?</p>
<p>Working through this logically:</p>
<p>Q1 - Is the lesion melanocytic? We have already answered this.</p>
<p>Q2 - Is the lesion symmetrical or asymmetrical? ... clearly asymmetrical.</p>
<p>Q3 - As per the algorithm is there at least one other atypical feature to suggest this lesion needs to be excised? If so what is it? The other main atypical feature is the eccentric structureless area (white circle). The clods are a little irregular, but not in a striking way. </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>The lesion was excised and the diagnosis was a melanoma of Breslow thickness 0.6mm.</p>
<p>In my experience, eccentric structureless areas are the one aspect of melanomas most commonly overlooked, probably because they sometimes give a bland appearance. </p>
<p>It is not unusual for benign lesions to have structureless areas but these tend to be more organised eg a small central brown structureless area, or, multifocal pale structureless areas around hair follicles in congenital melanocytic naevi. </p>
<p>Eccentric structureless areas found in some moderate-severely dysplastic naevi and melanomas can be brown, black, blue, pink or white (lighter than the surrounding skin) and tend to be less well organised ie irregular in shape and/or distribution thus giving the lesion an overall more asymmetrical appearance. </p>
