I am not sure i f this photo is of sufficient quality but I’s be interested in your thoughts . It stood out on the back of a 57 yr old woman
I was concerned that is was a reasonable size , had an irreg asymmetrical borer and a darker colour in the centre
This is a great case Alistair and excellent for the start of this Blog.
It highlights the way the algorithms of pattern analysis can quickly lead to a probable diagnosis.
Pattern Analysis consists of Pattern assessment followed by Colour assessment followed by Clues. Always remember PCC - pattern colour clues - I will be drumming this message on every blog!!! The order is the order of importance - pattern colour clues. Pattern is defined by pigment.
This case has a reticular pattern peripherally so immediately many diagnoses have been eliminated. You will also notice that there is chaos within the lesion - highly significant
There is more than one colour - brown blue and grey. The significance of blue and grey is that it means the melanin is in melanocytes in the dermis rather than melanin in keratinocytes in epidermis where the colour is brown and black. Grey and blue together are highly likely to be associated with Melanoma.
So you can see grey at 2, 9 and 11 o'clock as well as centrally where you can see some blueness as well.
Now to the clues -
- blue/grey structures centrally
- eccentric structureless areas
- thickened reticular lines
You are now in a position to make a probable diagnosis of Melanoma that is likely to be in situ.
So when you write to the histopathologist you are in a position to confidently say that Dermatoscopically this IS a Melanoma in situ at the least. This means that the histopathologist will take more slices and look more carefully. Even if the report from the histopathologist was not Melanoma in situ, this lesion should be treated as such - ie 5mm margin on initial removal at the least.
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