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Dermatoscopic images of four pigmented lesions each exhibiting chaos and the clue of peripheral black clods (arrows). melanoma in situ on the back
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Dermatoscopic images of four pigmented lesions each exhibiting chaos and the clue of peripheral black clods (arrows).nodular melanoma on the calf
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Dermatoscopic images of four pigmented lesions each exhibiting chaos and the clue of peripheral black clods (arrows). melanoma invasive on the abdomen
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dermascopic image of melanoma in situ exhibiting chaos and clues of thick rectilinear lines (arrows). They are located on the abdomen
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dermascopic image of melanoma in situ exhibiting chaos and clues of thick rectilinear lines (arrows). They are located on knee
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dermascopic image of melanoma in situ exhibiting chaos and clues of thick rectilinear lines (arrows).they are located on back
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dermascopic image of melanoma in situ exhibiting chaos and clues of thick rectilinear lines (arrows). They are located on the back
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Dermatoscopic lines radial segmental, in a melanoma in situ, extend from pigmented structures as dark as or darker than the radial lines.
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Dermatoscopic images of pigmented lesion exhibiting chaos and the clue of lines radial segmental (arrows). Melanoma in situ on the forearm
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Dermatoscopic images of pigmented lesion exhibiting chaos and the clue of lines radial segmental (arrows). melanoma in situ on the shoulder
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Dermatoscopic images of pigmented lesion exhibiting chaos and the clue of lines radial segmental (arrows).melanoma invasive on the back
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Dermatoscopic images of pigmented lesion exhibiting chaos and the clue of lines radial segmental (arrows).melanoma invasive on the posterior neck
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Dermatoscopic image of melanoma, with chaos and segmental lines radial (pseudopod type) (arrows).
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Dermatoscopic image of melanoma, with chaos and segmental lines radial (pseudopod type) (arrows).
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Dermatoscopic image of melanoma, with chaos and segmental lines radial (pseudopod type) (arrows).
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Dermatoscopic image of melanoma, with chaos and segmental lines radial (pseudopod type) (arrows).
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Polarised dermatoscopy of this melanoma in situ displays white lines which are seen to be in a perpendicularly orientated arrangement.
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Dermatoscopic images of two melanomas taken with polarised and non-polarised dermatoscopy. The invasive melanoma (upper images) exhibits polarising-specific white and blue lines.
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Dermatoscopic images of two melanomas taken with polarised and non-polarised dermatoscopy. some of which also correlate with non-polarising-specific white/blue lines
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In this dermatoscopic image, the clue of radial lines segmental (right and inferior portions of the image) overrides the clue of lines parallel in a furrow pattern (arrows). This is a melanoma arising in a volar (acral) naevus. Note that in the benign furrow pattern there is pigment over the ridges but the lines (as assessed at the edges) lie in the furrows.
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In this dermatoscopic image chaos and the clue of grey colour (arrow) point to malignancy. A pattern of serpentine vessels centrally, combined with a vast pattern of dot vessels is consistent only with melanoma; melanoma invasive1
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Dermatoscopic images of four lesions with various degrees of pigmentation, each exhibiting chaos and the clue of polymorphous vessels including a pattern of dot vessels. All are invasive melanomas, as is often the case by the time lightly pigmented melanomas are diagnosed, and all are located on the back.
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Dermatoscopic images of four lesions with various degrees of pigmentation, each exhibiting chaos and the clue of polymorphous vessels including a pattern of dot vessels. All are invasive melanomas, as is often the case by the time lightly pigmented melanomas are diagnosed, and all are located on the back.
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Dermatoscopic images of four lesions with various degrees of pigmentation, each exhibiting chaos and the clue of polymorphous vessels including a pattern of dot vessels. All are invasive melanomas, as is often the case by the time lightly pigmented melanomas are diagnosed, and all are located on the back.
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Dermatoscopic images of four lesions with various degrees of pigmentation, each exhibiting chaos and the clue of polymorphous vessels including a pattern of dot vessels. All are invasive melanomas, as is often the case by the time lightly pigmented melanomas are diagnosed, and all are located on the back.
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A large lesion on the abdomen of a 70-year-old man is symmetrical, but the dermatoscopic clue to growth of peripheral clods is not expected at mature age. The left border of the image (boxed in (B)) is enlarged in (A) showing the peripheral clods clearly: melanoma invasive
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images of a skin lesion on the chest of a 34-year-old man displaying only borderline asymmetry, but peripheral clods indicated that the lesion was growing. Under the age of 30 growth is expected, but at the age of 34 the lesion was assessed in context with other naevi on the patient. No others were found to have clues to growth. Excision biopsy revealed it to be a melanoma in situ.
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This pigmented skin lesion on the flank of a 60-year-old woman (A) was only 3mm in diameter and it was raised. Although it had dermatoscopic structural symmetry (B) it could not be recognised as a known benign lesion and there were two relevant exceptions: first, there was the dermatoscopic clue to change of peripheral clods and, secondly, it was both small and nodular with the clue of grey structures; nodular melanoma (Breslow thickness 0.9mm)11.
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Two lesions both with the dermatoscopic clue to change of peripheral clods. The lesion on the left was a growing naevus on the back of an adolescent (not excised). The lesion on the right was on the back of a 60-year-old woman (from Figure 6.38) and it was excised: nodular melanoma 3mm in diameter with a Breslow thickness of 0.9mm11. Note that the melanoma, although arguably symmetrical, has a disorganised structure compared to the naevus, consistent with the chaotic behaviour of malignant tissue.
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Two lesions both with the dermatoscopic clue to change of peripheral clods. The lesion on the left was a growing naevus on the back of an adolescent (not excised). The lesion on the right was on the back of a 60-year-old woman (from Figure 6.38) and it was excised: nodular melanoma 3mm in diameter with a Breslow thickness of 0.9mm11. Note that the melanoma, although arguably symmetrical, has a disorganised structure compared to the naevus, consistent with the chaotic behaviour of malignant tissue.
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Dermatoscopic images of lesion on the head or neck with varying degrees of symmetry and all exhibiting the clue of pigmented circles (arrows indicate representative pigmented circles). Chaos of border abruptness precludes the unequivocal diagnosis of any known benign lesion. Nasal side wall
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Dermatoscopic image of lesion on the head or neck with varying degrees of symmetry and all exhibiting the clue of pigmented circles (arrows indicate representative pigmented circles). Chaos of border abruptness precludes the unequivocal diagnosis of any known benign lesion. ear lobe
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Dermatoscopic image of lesions on the head or neck with varying degrees of symmetry and all exhibiting the clue of pigmented circles (arrows indicate representative pigmented circles). Chaos of border abruptness precludes the unequivocal diagnosis of any known benign lesion. neck
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Dermatoscopic images of four lesions on the head or neck with varying degrees of symmetry and all exhibiting the clue of pigmented circles (arrows indicate representative pigmented circles). Chaos of border abruptness precludes the unequivocal diagnosis of any known benign lesion. eyebrow: all are melanoma in situ.
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Dermatoscopic images of lesions on the head or neck with varying degrees of symmetry and all exhibiting the clue of grey colour (black arrows). Chaos of border abruptness precludes the unequivocal diagnosis of any known benign lesion. Cheek
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Dermatoscopic images of lesions on the head or neck with varying degrees of symmetry and all exhibiting the clue of grey colour (black arrows). Chaos of border abruptness precludes the unequivocal diagnosis of any known benign lesion. neck (note shiny white dots due to collision seborrhoeic keratosis (blue arrow)
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Dermatoscopic images of lesions on the head or neck with varying degrees of symmetry and all exhibiting the clue of grey colour (black arrows). Chaos of border abruptness precludes the unequivocal diagnosis of any known benign lesion. cheek
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Dermatoscopic images of lesions on the head or neck with varying degrees of symmetry and all exhibiting the clue of grey colour (black arrows). Chaos of border abruptness precludes the unequivocal diagnosis of any known benign lesion. ear lobe; all are melanoma in situ.
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This symmetrical (with respect to pattern, colour and border abruptness) pigmented skin lesion on the sole of a 55-year-old woman’s foot has a dermatoscopic pattern of lines parallel. Although pigment is present on both dermatoglyphic ridges and furrows, the pattern of lines, best assessed at the edges of the lesion, is a parallel pattern located on the broad ridges (black arrows) rather than the narrow furrows. Pigmented circles marking the centre of the ridges correlate with pigmented malignant melanocytes in the eccrine ducts (blue arrows).
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Clinical (A, B) and dermatoscopic (C, D) images of two lesions on the same 30-year-old woman. On the left thigh (A, C) is a lesion with the dermatoscopic pattern recognition features of a haemangioma (clods-only pattern with a few linear variants as commonly seen with very small haemangiomas). The lesion on the right thigh (B, D) does not have the pattern recognition morphology of any of the common benign groups so is analysed carefully. Polarising-specific white lines are clearly visible and take priority over vessels (there are none of the four benign vessel patterns anyway) leading to excision biopsy; amelanotic melanoma, Breslow thickness 0.8mm.
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Clinical (A, B) and dermatoscopic (C, D) images of two lesions on the same 30-year-old woman. On the left thigh (A, C) is a lesion with the dermatoscopic pattern recognition features of a haemangioma (clods-only pattern with a few linear variants as commonly seen with very small haemangiomas). The lesion on the right thigh (B, D) does not have the pattern recognition morphology of any of the common benign groups so is analysed carefully. Polarising-specific white lines are clearly visible and take priority over vessels (there are none of the four benign vessel patterns anyway) leading to excision biopsy; amelanotic melanoma, Breslow thickness 0.8mm.
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Dermatoscopic image of a lesion in which vessels are mostly centred in non-pigmented clods. The unequivocal white lines take priority over the vessels and mandate biopsy; nodular melanoma, Breslow thickness 2.5mm. While white lines may separate the clods in a haemangioma, the white lines in this lesion do not have the morphology of septa
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Dermatoscopic image of a hypopigmented melanoma with a polymorphous vascular pattern including linear serpentine vessels (centrally) and a vast pattern of dot vessels (peripherally).
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Dermatoscopic image of a hypopigmented melanoma with a polymorphous vascular pattern including patterns of linear (black arrows) and dot vessels (blue ar rows).
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Dermatoscopic images of pigmented skin lesions, one with one pattern (pigmented) lines reticular. Additional clues to the specific correct diagnosis of melanoma in each case include: grey structures (blue arrow) and focal thick lines reticular (black arrows);
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Dermatoscopic images of pigmented skin lesions,with a primary pattern of (white) lines reticular. Additional clues to the specific correct diagnosis of melanoma in each case include grey structures, an eccentric structureless (grey) area (blue arrow) and peripheral black dots (red arrows).
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Dermatoscopic image of pigmented lesions each with a pattern of lines angulated. The lesion shown arguably has a pattern of lines angulated-only, with the reticular lines scattered throughout the lesion not actually covering 20% of the lesion in any specific location; melanoma in situ.
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The lesion shown has a primary pattern of lines angulated combined with a structureless pattern; basal cell carcinoma. Because this is an extremely rare pattern in basal cell carcinoma it is not included in the aide-memoire – an incorrect prediction of melanoma will not impact the decision to biopsy.
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Dermatoscopic images of two pigmented lesions. (A) A lesion on volar (plantar) skin with a pattern of lines parallel (on the broad dermatoglyphic ridges) peripherally, combined symmetrically with a structureless pattern centrally; melanoma in situ. (B) A nail plate (thumb) with lines parallel chaotic (varying in width interval and colour); melanoma in situ of the nail matrix.
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Dermatoscopic images of two arguably symmetrical pigmented lesions each with a circumferential pattern of lines radial (including pseudopod type) or alternatively they may reasonably be described as peripheral clods. In such a situation the pattern can be regarded as a single pattern indicating peripheral growth and the provisional diagnosis depends heavily on the context. (A) This lesion with arguably symmetrical but internally disorganised morphology, on a 60-year-old, is consistent with melanocytic malignancy; nodular melanoma diameter 3mm and Breslow thickness 0.9mm.
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Dermatoscopic images of two arguably symmetrical pigmented lesions each with a circumferential pattern of lines radial (including pseudopod type) or alternatively they may reasonably be described as peripheral clods. In such a situation the pattern can be regarded as a single pattern indicating peripheral growth and the provisional diagnosis depends heavily on the context.This symmetrical lesion on an 8-year-old is predictably benign; Reed naevus
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Dermatoscopic images of pigmented lesion with a primary pattern of lines radial combined with a structureless pattern. (A) A chaotic lesion with lines radial segmental; melanoma in situ;
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Dermatoscopic images of pigmented lesion with a primary pattern of lines radial combined with a structureless pattern.a symmetrical lesion; recurrent naevus
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Dermatoscopic image of lesions with a pattern of circles only. A pigmented lesion on the face with a pattern of pigmented circles related to follicular openings; melanoma in situ.
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Dermatoscopic image of lesions with a pattern of circles only. A raised non-pigmented lesion on the ear with a pattern of white circles; squamous cell carcinoma.
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Dermatoscopic images of pigmented lesion located on facial skin. Predictably at this location the pigment is interrupted by follicular openings. A pattern of grey circles in a lesion with chaos of border abruptness is a compelling clue to the correct diagnosis of melanoma in situ
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Dermatoscopic images of two pigmented lesions located on facial skin. Predictably at this location the pigment is interrupted by follicular openings. the follicular openings (there are no circles) which interrupt the monotonous pigmented pattern of lines reticular/ curved are of no diagnostic significance; solar lentigo
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Dermatoscopic images of two pigmented lesions each with a pattern of clods-only. A pattern of clods varying in size, shape and colour, and with two colours, brown and grey, is suspicious for malignancy; melanoma in situ.
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Dermatoscopic images of two pigmented lesions each with a pattern of clods-only. a pattern of brown and white clods with symmetry – gradual transition from large to small and dark brown to light brown, is consistent with a diagnosis of (congenital) naevus.
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Dermatoscopic image of a structureless pigmented lesion. There is more than one colour and colours of melanin (brown and grey) predominate, being combined asymmetrically; melanoma invasive.
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Dermatoscopic images displaying features commonly observed in pigmented melanomas (insert images enlarged), asymmetry of colours
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Dermatoscopic images displaying features commonly observed in pigmented melanomas (insert images enlarged). radial lines
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Dermatoscopic images displaying features commonly observed in pigmented melanomas (insert images enlarged). lines radial (pseudopod type)
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Dermatoscopic images displaying features commonly observed in pigmented melanomas (insert images enlarged): peripheral clods.
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Dermatoscopic images displaying features commonly observed in pigmented melanomas (insert images enlarged): eccentric structureless areas
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Dermatoscopic images displaying features commonly observed in pigmented melanomas (insert images enlarged): angulated lines,
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Dermatoscopic images displaying features commonly observed in pigmented melanomas (insert images enlarged):pigmented clods separated by skin-coloured lines (‘inverse network’)
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Dermatoscopic images displaying features commonly observed in pigmented melanomas (insert images enlarged): thick reticular lines.
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Clinical (A), close-up (B) and dermatoscopic (C) images of a non-facial lentigo maligna (melanoma in situ) demonstrating dermatoscopic chaos plus grey structures and angulated lines (black arrows). A single grey circle (red arrow) would correlate with pigmented melanocytes extending into a follicle.
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Clinical (A), close-up (B) and dermatoscopic (C and D) images of a melanoma arising from a congenital naevus. This superficial spreading melanoma has a macular component with horizontal growth (red arrow) and an elevated portion with vertical growth (black arrow). While polymorphous linear vessels are seen in the elevated portion (D), increased footplate pressure in (C) blanches these vessels but reveals dot vessels in the macular portion.
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Clinical (A), close-up (B) and dermatoscopic (C and D) images of a superficial spreading melanoma with an invasive portion. The deeply invasive portion appears as structureless blue in both polarised (C) and non-polarised (D) images, because the melanocytes in the vertical growth phase are producing melanin, whereas those that are in the horizontal growth phase are not pigmented, this portion appearing red.
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Dermatoscopic images of two hypomelanotic melanomas, both demonstrating chaos with respect to the eccentric location of their focally pigmented components and with a polymorphous vessel pattern, including both linear and dot vessels. Polarising-specific white lines are also seen in (A).
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Dermatoscopic images of two hypomelanotic melanomas, both demonstrating chaos with respect to the eccentric location of their focally pigmented components and with a polymorphous vessel pattern, including both linear and dot vessels. Polarising-specific white lines are also seen in (A).
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images of a lesion of metastatic melanoma. Clinically there is a well-defined red nodule which dermatoscopically displays linear serpentine and looped vessels over a red and white structureless background.
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images of a volar melanoma which has a symmetrical pattern of lines parallel on the broad dermatoglyphic ridges. This is best appreciated at the edges of the lesion. Arrows point to pigmented circles caused by the presence of pigmented melanocytes in eccrine duct openings, these eccrine openings defining the centre of the ridges
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images of a pigmented lesion situated on Wallace’s line where volar (glabrous) skin meets non-glabrous skin. The volar pattern (inferiorly) is actually a parallel furrow pattern, but the lesion has irregularly dispersed portions on the non-glabrous component with thick reticular lines giving both chaos and a clue; melanoma in situ.
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images of a pigmented lesion situated on the foot. Dermatoscopically there is a parallel furrow pattern, best assessed at the margins (arrows), but over the upper and right sides of the image. a second pattern of lines radial segmental is evident; melanoma (invasive) associated with a volar naevus.
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Flat pigmented macule on the left temporal region of a 67-year old man. Dermoscopic examination showed angulated lines, including discrete rhomboidal structures (black arrow) and zig-zag pattern (white arrow) indicating the diagnosis of lentigo maligna. Atypical melanocytes with continual spreading along epidermodermal boarder without infiltration of dermis. Dermis shows solar elastosis
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The peripheral pigmented parts of the lesion as well as small isolated pigmented islands within the lesion showed annular granular pattern in a form of gray dots around hair follicles, while on the highly pigmented part of the lesion localized on the eyebrows obliterated hair follicles were detected which were in the form of structureless areas of dark brown and black coloration (Fig. 2.1b, c). Apart from those dermoscopic structures, the presence of grey color was one more indicator for being suspicious in favor of a lentigo type of melanoma. The presence of regression and obliterated hair follicles are both dermoscopic features of the invasive phase of lentigo maligna, e.g., lentigo maligna melanoma [1–3]. The patient was referred immediately to a plastic surgeon who excised the lesion and the lesion was histopathologically confirmed as a lentigo maligna melanoma, Breslow thickness 2.8 m.
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The dermoscopic evaluation revealed the presence of gray color through the lesion, annular granular pattern resembling grayish dots between follicular openings in the inner and central part of the lesion, while in the lateral part asymmetric pigmented follicles presented as gray circles within or around the follicular opening and angulated lines resembling a gray to brown lines forming a zig-zag and rhomboidal shapes at the upper part of the lesion were detected (Fig. 3.1b). All previously described dermoscopic structures characterized lentigo maligna melanoma [1, 2]. The patient was urgently sent for surgical excision, and the diagnosis of the invasive type of lentigo maligna, e.g., lentigo maligna melanoma was histopathologically confirmed, Breslow thickness 2.1 mm
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A pigmented lesion, irregularly shaped, located in the right preauricular region in a 46-year-old patient. Asymmetric pigmented follicles together with focal islands of obliterated hair follicles (black arrow) associated with the presence of grey color correspond to a diagnosis of lentigo maligna melanoma
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instead of a banal nevus, dermoscopic evaluation revealed the presence of gray color with the presence of grayish to brown colored angulated structures of complete or incomplete rhomboidal structures excluding a possibility of sending patient home or scheduling a follow-up, but sending him for a straightforward surgical excision of dermoscopically diagnosed lentigo maligna melanoma. The excision was performed, and a histopathological examination confirmed the dermoscopic diagnosis of lentigo maligna melanoma, Breslow thickness 0.6 mm.
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A 2 cm large pigmented lesion consisting of dark and light brown colorations located on the scalp on a 69-year old man.Dermoscopic examination revealed asymmetric pigmented follicles (black arrow) indicating the diagnosis of lentigo maligna.
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An ugly duckling lesion on the right scapular region of a 65-year old patient was noticed. The dermoscopic evaluation showed angulated lines (black arrow) indicating an extra-facial type of lentigo maligna melanoma
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Dermoscopic examination of the lesion showed an atypical pigment network at the periphery of the lesion, while in the central part area of regression with the presence of shiny white lines were detected, indicating the diagnosis of invasive melanoma. The lesion was excised, and a superficial spreading melanoma was pathohistologically confirmed, Breslow thickness 1.2 mm.
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Dermoscopic evaluation of the pigmented lesion on the left arm revealed an atypical pigment network throughout the lesion with the regression focal areas in the lower part of the lesion predominantly. Dermoscopic features of pigmented lesion indicate the presence of two superficial spreading melanomas at the same time in the same patient. Both lesions were excised, and histopathology revealed two superficial spreading melanomas, Breslow thickness 1.3 and 1.5 mm, respectively
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The dermoscopic examination of the second pigmented lesion located on the left scapular region showed similar dermoscopic findings, namely, an atypical pigment network at the periphery, while in the central part of the lesion regression areas with shiny white lines and irregularly distributed dots were noticed. Dermoscopic features of pigmented lesion indicate the presence of two superficial spreading melanomas at the same time in the same patient. Both lesions were excised, and histopathology revealed two superficial spreading melanomas, Breslow thickness 1.3 and 1.5 mm, respectively
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Clinical presentation of numerous seborrheic keratosis and solar lentigines on the back. A highly pigmented lesion, resembling a seborrheic keratosis located on the left arm. Dermoscopic examination showed an atypical pigment network (blue arrow), regression (pink arrow) and blue-white veil with a small gray-bluish dots in the central part of the lesion (white arrow), while at the periphery of the lesion radial streaks (black arrow) were detected
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Pigmented flat lesion, of roundish shape, with sharp demarcations, 2.2 × 1.8 cm in diameter, located on the left pectoral region. (b) Dermoscopic evaluation revealed peripherally distributed pseudopods, blue-whitish veil in the central part of the lesion, as well as atypical pigment network throughout the lesion
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Pigmented lesion, located on the left gluteal region, 2.8 × 2 cm in diameter, with sharp demarcation, and highly pigmented edges, while the central part was less pigmented. (b) Dermoscopic evaluation of the lesion revealed atypical pigment network at the periphery of the lesion (black arrow), regression area in the central part (circle) and blue-whitish vail (red arrow)
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A roundish shaped lesion, sharply demarcated, of light and dark brown coloration, diameter 1.3 × 0.8 cm, located on the left patient’s thigh. Dermoscopic examination revealed a prominent pigmented network on the edges of the lesion (black arrow), while in the central part of the lesion regression area are detected (red arrow)
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A small flat pigmented lesion, diameter 0.6 cm on the left shin. The dermoscopic examination of the lesion revealed peripheral pseudopods (black arrow)
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The clinical examination revealed a pigmented lesion with irregular shape and coloration, sharply demarcated with the largest diameter of 1.5 × 1 cm, located on the left upper arm. The dermoscopic examination showed a fine reticular pigment network, while in the central part a prominent pigment network was noticed
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Dermoscopic examination revealed atypical prominent pigmented network associated with whitish lines on the elevated part of the lesion, suggesting one more invasive melanoma (Fig. 17.1b) [1–3]. The patient was referred to a plastic surgeon for surgical excision and pathohistological examination, which revealed superficial spreading melanoma with the nodular component, Breslow thickness 2.6 mm
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Dermoscopic examination revealed fine and delicate reticular pigment network on the inner side of the lesion, while on the exterior side an atypical pigment network was detected, suggesting the diagnosis of early melanoma in situ. The lesion was surgically excised by a plastic surgeon, and pathohistological examination confirmed the dermoscopic diagnosis of melanoma in situ.
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Dermoscopic examination revealed an atypical prominent pigment network associated with whitish lines throughout almost the entire lesion indicating the diagnosis of early melanoma . The patient was sent to a plastic surgeon for surgical excision and pathohistological examination. The pathohistological examination confirmed the diagnosis of melanoma in situ.
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The dermoscopic examination revealed fine lines of reticular pigment network, but the presence of atypical pigment network on the lateral side of the lesion was evident, raising the level of suspicious . The patient was sent for a surgical excision by a plastic surgeon, and the pathohistological examination revealed a 0.4 mm Breslow thickness.
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peripheral dots, also known as pseudopods, were detected by dermoscopy. It is well known that dermoscopic appearance of peripherally distributed dots is pathognomonic for diagnosing melanoma. Besides pseudopods in this very case, a slightly atypical pigmented network was noticed in the central part of the lesion, leading to surgical excision of the lesion. A pathohistological examination of the suspected lesion revealed melanoma in situ.
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The dermoscopic evaluation revealed a structureless area, and the only dermoscopic feature was the presence of blue and black color. Although the lesion was small and clinically looked as benign, indicating the diagnosis of blue nevus, the dermoscopic appearance of both blue and black colors fulfilled the blue-black rule, led to a prompt excision avoiding misdiagnosing and follow-up of the suspected lesion. Histopathological examination confirmed the suspected dermoscopic diagnosis of nodular melanoma with a Breslow thickness of 2.2 mm.
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Dermoscopic examination showed the absence of standard dermoscopic features and the presence of black pigmentation on the top of the lesion, while on the surrounding parts, blue color with whitish lines was detected . The presence of blue and black color in the same lesion led to the decision of a prompt excision. However, histopathological examination of the lesion confirmed the diagnosis of a nodular melanoma with the Breslow thickness of 2.8 mm.
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