Is It Melanoma?-A Photo Essay

July 12, 2013

Here: short cases with photos that show melanoma, and pigmented lesions that mimic melanoma.

A 47-year-old woman with a history of non-melanoma skin cancer presented for a total body skin check. During the examination, a 5 3-mm pigmented macule was noted on the anteromedial aspect of the right foreleg. Most important, the asymptomatic lesion had a small spot of eccentric darker pigmentation. The patient was unaware of the questionable growth. This type of eccentric pigmentation strongly suggests malignant melanoma. Since the lesion was so small, it was excised with 5-mm margins. Histology demonstrated malignant melanoma in situ.

Image courtesy of Ted Rosen, MD.

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A 27-year-old woman noted a gradually increasing, asymptomatic dark spot on the right lateral thigh. The remainder of the cutaneous exam was normal. The patient's mother and sister had both had melanoma. When examined closely, the lesion does demonstrate a modest degree of asymmetry and pigment irregularity. The lesion was removed with 5-mm margins on all sides. Histology revealed a dysplastic nevus with moderate to severe cytologic atypia.

Image courtesy of Ted Rosen, MD.

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This lesion appears to be a melanoma because of its dark color, but it is benign. This is a blue nevus (dermal melanocytoma). Blue nevi are usually present from childhood, although they sometimes emerge in later life.

Image courtesy of William F. Keenan Jr, MD.

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A 44-year-old man was concerned about an asymptomatic dark lesion on his upper back, which his spouse alleged was “new.” The rest of the examination was normal. Family and past medical histories were non-contributory. The lesion is not very impressive, either in size or in morphologic features. However, on close examination, there is a “notch” in the superior pole, as well as some mild degree of pigment heterogeneity. The lesion was excised with 5-mm margins. Histology disclosed a malignant melanoma in situ.

Image courtesy of Ted Rosen, MD.

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A 13-year-old girl noticed that the skin around a “mole” on her abdomen had gradually changed color. The patient was told that she had a halo nevus-a pigmented (nevocellular) nevus surrounded by a tight ring of depigmentation-which is benign and usually regresses spontaneously over time. Halo nevi have often been found in persons with malignant melanoma. However, biopsy and referral to a dermatologist are generally indicated for patients with lesions in which the central nevus demonstrates atypical features.

Image courtesy of Bhagwan Das Bang, MD.

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A 58-year-old man presented for care when he noticed a flat, dark area on his left upper arm. The lesion was set against a background of fairly severe photodamage. Family history was positive for melanoma (mother and 1 of 4 sisters). The almost black nature of the lesion arouses suspicion for melanoma. This diagnostic concern is augmented by the variability in lesion color apparent on the close-up view. A conservative excisional biopsy, however, revealed this to be a traumatic tattoo (accidental or deliberate implantation of a dark-colored material, such as graphite or metal, into the dermis).

Image courtesy of Ted Rosen, MD.

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