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A 45-year-old female with Fitzpatrick skin type II, a history of previous non-melanoma skin cancers, and more than five atypical nevi presents with a pigmented lesion on the right lower leg. The lesion shows an irregular shape, ill-defined borders, asymmetry, atypical pigment network, and multiple colors. Dermoscopic evaluation reveals atypical features including irregular streaks, blotches, and an area of regression.
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Dermoscopy in early demonstration of treatment response in melasma. Dermoscopic image from an untreated macule of melasma over the cheek of a woman displaying a diffuse nonspecific pattern of dark brown pigmentation with plentiful scattered dark brown globules and clods with perifollicular sparing and multiple prominent telangiectasias
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Dermoscopic examination showing yellow dots (blue circle), linear yellow-white streaks (blue arrow), and linear branched vessels (black arrow) over a diffuse reddish-orange background.
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A 28-year-old woman presented with a long history of a mole on her leg that had been changing in shape and size over the previous few months. There was no personal or family history of skin malignancy.On examination, there was a reddish well-circumscribed plaque on the side of her left thigh. Clonal seborrheic keratosis. Well-circumscribed reddish patch with slightly scaly surface.Dermoscopy showed diffuse pinkish background, white network, and multiple vessels (glomerular, linear-irregular, and dotted vessels). Clonal seborrheic keratosis. Dermoscopy shows a vascularized lesion with diffuse pinkish background, white network, and multiple vessels.
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polarized dermoscopic image taken at the follow-up visit still shows milia-like cysts and comedo-like openings (D, black and white arrows, respectively), a bluish veil (D, red asterisks), an atypical pigment network (D, black asterisks), and irregular blood vessels (D, white asterisks) can be appreciated
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Low-magnification polarized dermoscopic image of lesion at baseline. When the central area with the typical SK-like features is blocked from view, the features of an atypical melanocytic lesion can be appreciated.
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Dermoscopic features of a pigmented lesion on the face. Note the highly characteristic pseudonetwork, specific to this location. The presence of asymmetric pigmented follicular openings suggested a diagnosis of lentigo maligna, which was subsequently confirmed by histology
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Dermoscopic features of lentigo maligna. A, Asymmetric pigmented follicular openings (black arrows)
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Dermascopic features of lentigo maligna. Lines starting to intersect (white arrows) to form rhomboidal structures (black arrows).
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Dermascopic features of lentigo maligna. Gray dots (black arrows) forming a granular-annular pattern and asymmetric pigmented follicular openings (white arrows)
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Dermascopic features of lentigo maligna. Homogeneous areas with obliteration of the follicular openings (red arrow) and a whitish scar-like area
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Lentigo maligna. Flat brown symmetric lesion with a diameter of 6mm on the right cheek of an adult. Dermoscopic features: asymmetric pigmented follicular openings (black arrows).
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Additional dermoscopic features of lentigo maligna. Increased vascular density (black arrows) together with asymmetric pigmented follicular openings and gray dots
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Red rhomboidal structures (black arrows) and a gray granular-annular pattern.
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Target-like pattern (white arrows) and rhomboidal structures.
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Detection of darker colors in the dermoscopic examination compared with naked-eye inspection (box)
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Dermoscopic features: asymmetric pigmented follicular openings (black arrows), gray dots forming granular-annular pattern (white arrows), and brown structureless areas.
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Dermoscopic features of extrafacial lentigo maligna; lesions located on the upper limbs. Note the gray dots forming a granular-annular pattern in some sectors, the brown structureless areas, and the rhomboidal structures (black arrows).
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Dermoscopic features of extrafacial lentigo maligna; lesions located on the upper limbs. Note the gray dots forming a granular-annular pattern in some sectors, the brown structureless areas, and the rhomboidal structures (black arrows).
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Dermoscopic features of extrafacial lentigo maligna; lesions located on the upper limbs. Note the gray dots forming a granular-annular pattern in some sectors, the brown structureless areas, and the rhomboidal structures (black arrows).Lesion is lentigo maligna melanoma; note the whitish-blue veil.
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Dermoscopic features of extrafacial lentigo maligna,lesions located on the upper limbs. Note the gray dots forming a granular-annular pattern in some sectors, the brown structureless areas, and the rhomboidal structures (black arrows).
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Conditions to be considered in the differential diagnosis of lentigo maligna. Solar lentigo: moth-eaten border (red arrow), jelly sign (white arrows), and pseudonetwork (black arrows).
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Seborrheic keratosis: pseudo-milia-like cysts (black arrows) and pseudo-follicular openings (white arrows).Pigmented actinic keratosis: gray dots forming a granular-annular pattern (black arrows).
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Pigmented actinic keratosis: gray dots forming a granular-annular pattern (black arrows).
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Lichenoid keratosis: gray dots and globules forming a granular-annular pattern (black arrows).
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An uneven (asymmetric) melanoma with an irregular but distinct border. The melanoma is more than 20 millimeters wide (about the size of a postage stamp).
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A blue-black melanoma that has irregular and scalloped borders. It has arisen from a dysplastic nevus (the pink-tan region at the upper left). The melanoma is about 12 millimeters wide (nearly 1/2 inch).
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A melanoma with three parts—a dark brown or black area on the left, a red bump on the right, and an area that is lighter than the skin at the top. The melanoma is about 15 millimeters wide, or about as wide as a tube of lip balm.
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Chaos and clues in melanoma. Asymmetry of structure and color (“chaos”); clues to malignancy: eccentric structureless zone, gray dots, on the left side, black dots in the periphery, thick reticular lines. Histopathologic diagnosis: melanoma
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Chaos and clues in melanoma, Asymmetry of structure and color (“chaos”); clues to malignancy: eccentric gray and blue structureless zone, black dots in the periphery, segmental radial lines at the periphery, white lines. Histopathologic diagnosis: melanoma.
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Prominent skin markings and angulated lines in melanoma in situ. a Dermatoscopic image of a melanoma in situ on the thigh of a 68-year-old man.shows prominent skin markings (linear intersecting furrows) as a clue to melanoma in situ. Angulated lines and eccentric irregular hyperpigmented area as clues to melanoma in situ.
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Pigmented actinic keratosis. Lesions show surface scaling and follicular openings. characteristic rosettes (4 dots arranged in square) can dermatoscopically be seen.The presence of angulated lines in both lesions are in line with the diagnosis of pigmented actinic keratosis.
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Acral lentiginous melanoma in situ of a 37-year-old woman. Dermatoscopy shows longitudinal lines of irregular thickness, spacing, and coloration. Note that the pigmentation involves less than 1/3 of the nail plate, demonstrating that size is not a good criterion for early lesions
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Hypopigmented nodule on the back of a 72-year-old man viewed with the unaided eye.Dermatoscopic examination of lesion shows ulceration with serum crusts and adherent fibers. Central gray color surrounded by white lines and coiled vessels allows the differential diagnosis of an amelanotic melanoma. Histopathologic diagnosis: nodular melanoma (Clark level, IV; Breslow depth, 2.4 mm; ulceration, stage T3b)
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. Lesion shows the typical features of an infiltrative BCC such as branched vessels and small blue clods.
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The superficial BCC in is typified by white lines.
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Highly differentiated SCC, in a 72-year-old man. Dermoscopy shows keratin with blood spots in the center and white circles in the periphery
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Dermoscopic image of early invasive melanoma. Regression structures, combinations of white areas and blue areas (blue-whitish areas) are seen on the left-hand side of the lesion. At the periphery, irregular dots/globules (bottom left and top right), atypical pigment network, and irregular streaks (top right) are further dermoscopic criteria suggestive of melanoma (original magnification × 10)
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A 35-year-old male with a history of atypical mole syndrome (>50 nevi) and severe sundamage (skin type II) presented with a lesion on the anterior trunk. The lesion, measuring 7 x 9 mm, exhibited multiple colors (light and dark brown, pink, reddish, black to bluish) and an irregular shape with ill-defined cut-off. Dermoscopic examination revealed asymmetry, multiple colors, atypical globules and dots, homogeneous areas, atypical vessels, atypical network, and regression structures (blue dots). The lesion demonstrated a significant change in size and color in recent months, with a previous history of bleeding. Diagnosis: thin malignant melanoma with regression structures. Recommended management: surgical excision with 2 mm margins and subsequent histopathologic examination. Specific comments: asymmetrical lesion with regression structures, focal presence of pigment network and globules, previous bleeding (ulceration). Multiple step-sectioning recommended.
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Examples of the most significant differences between nevi examined in winter and in summer. Winter nevus with delicate PN; black dots located at center show homogeneous shape and size; focal areas of depigmentation visible at center.
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Summer nevus with broader, more prominent PN; black dots involve periphery and vary in size; periphery shows areas of pronounced depigmentation. (Original magnification × 25.)
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Example of dermoscopic changes caused by UVB therapy in unprotected nevi.Dermoscopic image of nevus before UVB therapy.
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Dermoscopic image of same nevus after UVB therapy for 4 weeks (total radiation dose 472 mJ/cm²). Note increase in total irregularity (arrows) and darkening of brown color.
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Example of dermoscopic changes caused by UVB therapy in unprotected nevi. Dermoscopic image of nevus before UVB therapy
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Dermoscopic image of same nevus after UVB therapy for 11 weeks (total radiation dose 1656 mJ/cm²). Note increase in brown globules and darkening of brown color.
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Clinical view of melanoma in situ located on occipital region of scalp revealing asymmetric, sharp demarked macule characterized by inhomogeneous pigmentation varying from black to brown.
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Dermoscopically, lesion reveals multicomponent global pattern typified by atypical pigment network (white asterisk) with streaks at periphery and regression structures (white scarlike areas, black asterisk)
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Atypical network is superimposed on grayish background (pepperlike granules) in another part of lesion (asterisk).
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A 60-year-old man presented with an asymptomatic pigmented macule on his left arm, characterized by numerous patchy macules ranging from light brown to brown. Dermoscopy showed a homogeneous reticular pattern with circular macules, homogeneous areas, and hypopigmented spots. The lesion was diagnosed as Nevus Spilus (NS), a rare dermatologic entity marked by multiple pigmented macules or papules within a pigmented patch, commonly located on the trunk, extremities, and head. Dermoscopy typically reveals darker brown areas with a reticular and globular pattern, with clear and brown lattice at the bottom.
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Circular macules and homogenous areas, dots, varying in color from light to dark brown, with hypopigmented areas.
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Dermaphoto (10X) of a compound melanocytic nevus with a cobblestone pattern. Observed the “fitted” distribution of globules.
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Macro photography and dermaphoto (10X) of a cutaneous melanoma. Observe the multicomponent pattern with an enlarged network, black dots, peripheral brown dots, and multiple colors (light brown, dark brown, blue, and black).
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Dermaphoto (10X) of a compound melanocytic nevus. Note peripheral regular pigmented network, central homogeneous area, and central black dots.
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Macro photography and dermaphoto (10X) of a compound congenital melanocytic nevus. Observe areas with abundant structures amidst areas with no structures (monotonous pattern).
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Dermaphoto (10X) of a blue nevus. Notice a homogeneous blue-greyish pattern, with absence of pigmented network, dots and globules, and central hypopigmented area.
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Macro photography and dermaphoto (10X) of a cutaneous melanoma. Observe the presence of a bluish veil, branched streaks, and blotches.
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Macro photography and dermaphoto (10X) of a pigmented basal cell carcinoma. Note the large ovoid nests and spoke wheel structure.
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Nevus1, Spitz Nevus, 7 y.o. male, lower leg,
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Reed nevus, 2 y.o. female, upper limb
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Miescher nevus, 39 y.o. female, back
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Lentigo maligna melanoma (LMM) 1, 65 y.o. male, face
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Lentigo maligna melanoma (LMM) 2, 75 y.o. male, face
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Superficial spreading melanoma (SSM), 49 y.o. female, lower leg
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Magnified dermoscopic image of irregular network. 2D vertical view image, reconstructed 2D top-down view image, and 3D aerial view image are shown in Spitz nevus.Dotted line in vertical view image shows the level of depth in top-down view image.
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Magnified dermoscopic image of irregular network. 2D vertical view image, reconstructed 2D top-down view image, and 3D aerial view image are shown in superficial spreading melanoma (SSM).Dotted line in vertical view image shows the level of depth in top-down view image.
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Magnified dermoscopic image of pseudonetwork, 2D vertical view image, reconstructed 2D top-down view image, and 3D aerial view image. In the lower left panel, an arrowhead shows crescent structure in dermoscopy, and an arrow shows a projection of invading pigmented cells.
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Magnified dermoscopic image of pseudonetwork, 2D vertical view image, reconstructed 2D top-down view image, and 3D aerial view image. In the lower left panel, an arrowhead shows crescent structure in dermoscopy, and an arrow shows a projection of invading pigmented cells.
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Magnified dermoscopic image of dots, 2D vertical view image, reconstructed 2D top-down view image, and 3D aerial view image. Dotted line in vertical image shows the level of depth in top-down image.Dots structure and its correlation with histopathological morphology. Magnified dermoscopic image of dots, 2D vertical view image, reconstructed 2D top-down view image, and 3D aerial view image are shown in Spitz nevus. Dotted line in vertical image shows the level of depth in top-down image.
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Black nodular lesion located on the scalp. Dermoscopy: asymmetry of outline, color, and structures, blue-white veil, large blue-grey structureless area, structureless brown area at 5-7 o’clock and crusting on the surface.
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Dark-brown nodule located on the back. Dermoscopy: sharply circumscribed lesion, with different shades of brown and red color, blue-white veil, white shiny lines, scaling on the surface, and a small bright red nodular lesion at 3 o’clock on one edge.
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Darkly pigmented nodular lesion with slightly keratotic surface located on the arm. Dermoscopy: asymmetry of colors and structures, multiple colors (brown, black, and grey), blue-white veil, irregularly sized and shaped globules unevenly distributed throughout the lesion, and scaling on the surface.
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Superficial spreading melanoma with a Breslow index of 0.8 mm on the neck. Dermoscopy shows asymmetry in two axes, 3 colors, atypical pigment network, asymmetric pigment blotch, irregular streaks.
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Lentigo maligna melanoma in situ on the cheek. Dermoscopy shows asymmetry in two axes, 3 colors, atypical dots, structureless area, scar-like depigmentation, atypical network.
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Superficial spreading melanoma with a Breslow index of 1.3 mm on the cheek. Dermoscopy shows asymmetry in two axes, 4 colors, atypical network, streaks, atypical dots and globules, irregular vascularity.
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Superficial spreading melanoma with Breslow 0.6 mm located on the leg. Dermoscopy shows asymmetry, atypical network, atypical dots and globules, regression structures, atypical vessels, and a milky-red area, featuring a multicomponent pattern.
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Superficial spreading melanoma with Breslow 0.5 mm located on the cervical region. Dermoscopy shows asymmetry of contour, colors, and structures, atypical network, atypical dots and globules, radial streaks and pseudopods, and whitish-blue veil, featuring a multicomponent pattern.
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Lentigo maligna melanoma in situ on the foot. Dermoscopy shows asymmetry in two axes, two colors, atypical dots and globules, and structureless area.
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Superficial spreading melanoma with a Breslow index of 0.5 mm in the cervical region. Dermoscopy shows asymmetry in two axes, four colors, atypical globules, streaks, and milky red area
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Superficial spreading melanoma with a Breslow index of 0.9 mm on the forearm. Dermoscopy shows asymmetry in two axes, 4 colors, atypical network, streaks, atypical dots and globules, blue-white veil, and multiple blue-gray dots.
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Multiple red, roundish, small papules with fine superficial scaling appeared on the lower limbs of a 35-year-old man after a streptococcal infection.Clinical image showing the lesions on the lower limbs. Dermoscopy revealing dotted vessels over a pinkish background and superficial white scales.
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Numerous roundish, red to pink papules and plaques on the lower limbs of a 79-year-old man persisted after several topical treatments and phototherapy. Dermoscopy showing a peripheral white rim with multiple dotted and linear irregular vessels.
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The 31-mm ALMIS showed asymmetry, parallel ridge pattern, and irregular diffuse pigmentation.Clinical image of the 31-mm ALMIS on the foot.
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The 31-mm ALMIS showed asymmetry, parallel ridge pattern, and irregular diffuse pigmentation. Dermoscopic image of the 31-mm ALMIS showing asymmetry, parallel ridge pattern, and irregular diffuse pigmentation.
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An irregular plaque with a scab on the inside of the left nipple.
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The dermoscopic findings included a bright red background, apparent central keratosis with erosion and blood scabs, and tortuous dilation of peripheral dendritic vessels at the edge. Dermoscopic image showing central keratosis and erosion with a bright red background
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The dermoscopic findings included a bright red background, apparent central keratosis with erosion and blood scabs, and tortuous dilation of peripheral dendritic vessels at the edge. Dermoscopic image highlighting blood scabs and dilated peripheral dendritic vessels.
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Atypical ulcer arising on stasis dermatitis of the right leg. The dermoscopy highlights the presence of red globules, gray-to-blue veil, irregular vessels, and remnants of pigmented ridge pattern.
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Red papule in the right popliteal fossa of a 42-year-old woman.Dermoscopic image of the lesion showing a whitish lesion with irregular, slight brown pigmentation at the periphery. The reddish color observed in the macroscopic view (A, B) disappears due to the pressure of the glass plate of the dermoscopy camera.The lesion was excised and reported as superficial spreading melanoma, Breslow thickness < 0.5 mm.
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Melanoma in a 50 year woman. Macroscopic image of a 5-mm reddish-brown papule with a shiny surface.Dermoscopic image of the lesion showing inhomogeneous pigmentation with a greyish patch comprising irregular dots/globules and a delicate blue-whitish veil. Note the irregular network on the right-hand side.Histopathology showed a highly suspicious melanocytic lesion, which was eventually diagnosed as melanoma (Breslow thickness 0.9 mm).
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Melanoma among several seborrheic keratoses on the back. Non-polarized dermoscopic images of SKs showing a dull surface, including fingerprint and cerebriform patterns, milia-like cysts (yellow arrows), and comedo-like openings (black arrows).
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Melanoma among several seborrheic keratoses (SK) on the back.Dermoscopic image of melanoma containing an irregular pigment network and blue-white veil with multiple colors.
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A solitary palpable protruding greyish nodule on the left labia minora (black arrow) of a 72-year-old female.Histological examination reveals a cystic structure in the deep dermis. The cyst wall containing melanin pigments is lined by layers of cuboidal and transitional epithelium.
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nodular melanoma on leg. A 45-year-old man presented with an enlarging tumor on his leg, first noticed a year ago. The lesion was excised, and pathology revealed malignant melanoma with a Breslow thickness of 4 mm. The scar was re-excised with a 2 cm margin, and the sentinel node biopsy was negative. Dermoscopic examination revealed a blue-white veil and irregular pseudopods.
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Superficial spreading melanoma.Non-polarising Dermlite Fluid. Pattern is clods brown and black, with some peripheral lines reticular. Clue to melanoma, structureless white.History is of a macule arising on the upper arm 3 years previously, which shrank and was replaced by the nodule now apparent. There is a small part of the previous macule still visible. The histology was reported as; Sections show an early level 4 (1.5 mm thick) superficial spreading melanoma. There is no ulceration. The mitotic count is low. There is a mild lymphocytic infiltrate in the base. There is no significant regression in the lesion. The other lesion is an almost completely regressed solar lentigo.
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invasive melanoma. Lady in her 40s with two previous in situ melanomas. This one was invasive 0.4 mm but her prognosis is still excellent. Dermatoscopically, there were lines radial peripheral parallel, a few pseudopods, dark dots, and thickened lines reticular.thickened network.
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Pigmented Basal cell carcinoma in 60 year old male.Clod-like pattern, no reticular network, straight lines, white and pink structureless areas with brown dots.This BCC was picked up along with two other pigmented BCCs on this patient's chest and back.
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pigmented basal cell carcinoma in 67 year old female.This shows blue clods with prominent arborising telangiectasia and blue dots.This lesion grew slowly over a 6 month period.
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A pink tumor with a central serohemorrhagic crust at the temple.
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Large blue-grey ovoid nest (black arrow) and structureless white areas (blue asterisks) on dermoscopy
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progression of malignant melanoma: Plaque with amelanotic nodule.
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