Dermoscopy Superficial Spreading Melanoma 2 | Dermatology Education Dermoscopy Superficial Spreading Melanoma 2 Video
August 13, 2020

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Dermoscopy Superficial Spreading Melanoma 2

This is a picture of a pigmented lesion that appears to be suspicious. There is an irregular border, there is notching in one area, the pigmentation is dense in the center, there is an area of hypo-pigmentation that is pink out here on the edge. So our initial impression is that this is a worrisome lesion even before we view it with a Dermoscope.

Lets look at the lesion now with the Dermoscope. We will analyze the pigment network first. Here the pigment network looks quite regular; there is a net-like pattern, the lines are quite uniform, and it blends out near the periphery. However, the net-like pattern is lost in these areas. Here it again seems to be quite normal. There is a bluish-white area typical of a bluish-white veil in the center; this was not apparent when the lesion was viewed with low-powered magnification. There does not seem to be any atypical vascular pattern. We will look at the periphery for streaks. I do not see any finger-like projections extending from the periphery. The pigmentation is quite irregular; it is very dense in this area, as it is in these other areas. The pigmentation is black, indicating that the melanin is high in the epidermis. I do not see any irregular dots or globules, and there are essentially no regression structures.

Lets look at a high-power view of the same lesion. This area shows a well-organized reticular pattern; the lines are of uniform thickness, there is a net-like pattern. This is what we see in a benign lesion, and this suggests that this atypical area originated from this benign lesion which might have been a junction-nevus or a Lentigo. I will progress over to this area and see whether the pigmentation is quite dark, this suggests that melanin is being deposited in the epidermis and possibly high in the epidermis. There is a bluish-white area suggestive of a bluish-white veil, which we saw in the lower-power view. So the pigmentation is irregular throughout this area, there are no psuedopods or streaking in here, there is smudging and if you look carefully you can see little black dots.

Lets look at the right hand border. The edge is highly irregular, there is no structure, the pigmentation is irregular, the pigmentation is irregular in this area also and much darker. Now we can see dots. The dots vary in size and distribution. There are tiny black dots in this area. There is a bluish-white veil. It looks blue in this area and pink here. So this lesion, at this magnification, is highly variable. We have to conclude from all of these characteristics this is, with great certainty, a superficial spreading melanoma.