The pattern is that of blue/grey clods with the clods arranged in a pattern of their own ( used to be called the maple leaf effect) The surrounding skin coloured area looks raised and the central vessels are called are polymorphous with curved, branching and serpentiine vessels that suggest that it is in deed a raised lesion. The most likely Dx here is a pigmented nodular BCC and the differential includes Melanoma and Seborrheic Keratosis.
I have uploaded this image from a patient I saw a few days ago that has similar features to the case above but not quite so obvious. Once again the pattern is that of brown/grey clods and there is chaos. The clinical appearance is often very important in these cases as they feel raised and the surface glistens as though the skin is being stretched and you would imagine that there was fluid underneath. Once again this is likely to be a pigmented BCC. It is difficult to see the blood vessels in this case as it is an earlier lesion so is unlikely to be nodular - more likely to be a superficial BCC. BCC's are an excellent example of why taking pictures of skin is not sufficient. Feeling the lesions is part of the assessment.
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