Trunk and Extremities in .NET

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3
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3-1a
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Nevus Seborrheic keratosis Basal cell carcinoma Vascular Dermatofibroma Squamous cell carcinoma Melanoma Other
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No intervention Follow-up Histopathologic diagnosis
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CASE 1
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HISTORY
A 32-year-old man has many small banal appearing nevi on his trunk and extremities A nevus on his left arm looked different than the others 1 2 3 4 5 This is a melanocytic lesion because there is a pigment network It has a reticular global pattern There is symmetry of color and structure A uniform, regular pigment network fills most of the lesion Multifocal hypopigmentation and irregular pigment network diagnose a moderately dysplastic nevus
3-1b
DERMOSCOPY: AN ILLUSTRATED SELF-ASSESSMENT GUIDE
RISK
Low Intermediate High
DIAGNOSIS
Nevus Seborrheic keratosis Basal cell carcinoma Vascular Dermatofibroma Squamous cell carcinoma Melanoma Other
DISPOSITION
No intervention Follow-up Histopathologic diagnosis
ANSWERS
Answers: 1,2,3,4
Discussion:
DERMOSCOPIC CRITERIA
Regular pigment network (black boxes) Irregular pigment network (white boxes) Multifocal hypopigmentation (black arrows)
Melanoma is in the clinical differential diagnosis because there are slightly irregular borders, several dark colors, and it is an ugly duckling One will not see the entire picture until the lesion is examined with dermoscopy It could have looked much worse! The ugly duckling is a pigmented skin lesion that clinically and/or dermoscopically is different from the other lesions on a patient An ugly duckling lesion is a red flag for concern; however, it is not always high risk The dermoscopic picture seen here should give one reassurance that this is not a melanoma By definition this is the reticular global pattern because the lesion is made up of pigment network There are foci of irregular pigment network with broadened, branched, and broken up line segments Irregular pigment network is not always associated with high risk pathology Multifocal hypopigmentation and irregular pigment network can be found in dysplastic nevi The hypopigmentaion could represent normal skin that commonly is found in melanocytic nevi There are no well-developed melanoma-specific criteria, aka high risk criteria
PEARLS
If in doubt cut it out With experience one will become less and less concerned with this entire clinical scenario Digital clinical and dermoscopic monitoring for changes over time is a cutting-edge way to handle this case An experienced dermoscopist would find this lesion perfectly banal appearing
3-1c
3
Trunk and Extremities
RISK
Low Intermediate High
DIAGNOSIS
Nevus Seborrheic keratosis Basal cell carcinoma Vascular Dermatofibroma Squamous cell carcinoma Melanoma Other
3-2a
DISPOSITION
No intervention Follow-up Histopathologic diagnosis
CASE 2
HISTORY
This asymptomatic pigmented skin lesion was found by a dermatologist while performing total body skin examination 1 Compared to Case 1, the global dermoscopic picture is more worrisome 2 There is definite asymmetry of color and structure 3 Asymmetry of color and structure, irregular blotches, and foci of regression characterize this in situ melanoma 4 This could be a dysplastic nevus characterized by asymmetry of color and structure, irregular pigment network, and multifocal hypopigmentation 5 Skin markings traversing the lesion are creating the linear hypopigmentation
3-2b
DERMOSCOPY: AN ILLUSTRATED SELF-ASSESSMENT GUIDE
RISK
Low Intermediate High
DIAGNOSIS
Nevus Seborrheic keratosis Basal cell carcinoma Vascular Dermatofibroma Squamous cell carcinoma Melanoma Other
DISPOSITION
No intervention Follow-up Histopathologic diagnosis
ANSWERS
Answers: 1,2,4,5
Discussion:
DERMOSCOPIC CRITERIA
Asymmetry of color and structure (+) Irregular pigment network (black boxes) Multifocal hypopigmentation (black arrows)
Compared to Case 1 the global/overall dermoscopic picture is more worrisome The irregular pigment network is more widespread than in Case 1 Linear hypopigmentation is commonly seen and is created by the normal skin markings that traverse the lesion The bony-white color of regression is not seen A banal acquired nevus and mildly dysplastic nevus are in this differential diagnosis Melanoma is not in the clinical and dermoscopic differential diagnosis Multiple similar appearing nevi are less worrisome than a single lesion that looks like this
PEARLS
For the novice dermoscopist, digital clinical and dermoscopic monitoring for changes over time would be a cutting-edge way to handle this case An experienced dermosopist might find this lesion perfectly banal appearing and find no need for follow-up
3-2c
3
Trunk and Extremities
RISK
Low Intermediate High
DIAGNOSIS
Nevus Seborrheic keratosis Basal cell carcinoma Vascular Dermatofibroma Squamous cell carcinoma Melanoma Other
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