Dermoscopy Superficial Spreading Melanoma 3 | Dermatology Education Dermoscopy Superficial Spreading Melanoma 3 Video
August 13, 2020

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Dermoscopy Superficial Spreading Melanoma 3

This is a magnified view of a pigmented lesion. Our first impression is that this is a melanoma. The border is irregular and there is notching. The pigmentation pattern is highly irregular. There is a bizarre black structure on the edge. There is variable pigmentation. We have red, light brown, red again, dark brown and there are some dots. Even without the Dermascope, we are going to manage this as a superficial spreading melanoma.

Lets examine the entire lesion with the Dermascope. The most obvious feature are these large streaks that are everywhere in the lesion. This looks like the branch of a tree. These lines are very dense and they end in little globules. That is characteristic of a melanoma. There are some black dots that are quite uniform in size, and they are not uniformly distributed throughout the lesion. Then we have this other area at the boarder that we saw at low magnification as black. There are prominent streaks that suggest that malignant cells are radiating through the epidermis. There is a background of homogeneous brown pigmentation. This suggests a bluish-white veil, although it is not as obvious as some of the other lesions we have examined. Our impression of this bizarre structure is that this is a superficial spreading melanoma.

This is a higher power view of the black area. You can appreciate how thick these lines are and that there is no uniformity whatsoever. There are little black globules at the end of the streaks. These cells must be close to the surface of the skin because they are depositing melanin that appears black. The cells here are probably deeper because it is brown. Again you can see the lines are much thicker than the lines seen in the reticular pattern of a lentigo or junction nevus. There is a blue-whitish translucent area suggestive of a bluish-white veil. This has got to be a superficial spreading melanoma.