Dermoscopy Superficial Spreading Melanoma 1
Superficial Spreading Melanoma
This is a low-powered dermoscopic view of an entire lesion. Our initial impression of this lesion is that it is highly disorganized and probably a superficial spreading melanoma, but we are going to examine all of the components and use the 7-Point Checklist. Let us look at the pigment network. In this small area here it appears typical; the lines are uniform, the circles are uniform. When we come to this part of the lesion we see that the lines are dense, they are disorganized, they don’t form a net-like or reticular pattern over this very wide area. There is a very definite and prominent bluish-white veil here and in this area. These areas are translucent; they have a light, faint, blue color in the background indicating melanin pigmentation in the upper and lower dermis. These are highly characteristic features of superficial spreading melanoma. This area, in contrast, looks like an area of regression; it is smoother, and a brighter white.
There is an atypical vascular pattern, here, here, and here; small, red dots. When you examine the periphery of the lesion I don? see any finger-like projections, so there are really no irregular streaks. The pigmentation is irregular; dark here, lighter here, and even lighter in this area. It is highly disorganized. There are a few dots, but no larger dots that I would describe as globules, and then there is this regression structure that I mentioned before. So this lesion has an atypical pigment network, a bluish-white veil, an atypical vascular pattern, we do not see any irregular streaks, the pigmentation is irregular, there are a few irregular dots and globules, and there are regression structures. So there is little doubt of the diagnosis. This is a superficial spreading melanoma.
Now lets look at the high-powered view. The bluish-white veil is prominent. Now you get a better feeling for the blue tinge in the background indicative of melanin pigmentation deeper than the epidermis. Here are the atypical vascular structures; they are not prominent and are often difficult to see even with the Dermoscope. The pigment network is highly disorganized; there is no regular net-like pattern, the lines are thick and they are joined in an unusual manner. This is the corner of that regression structure; it is smoother, a little brighter, but in many instances it is difficult to distinguish from the bluish-white veil.