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301 | Dermoscopic examination revealed the absence of a typical
pigmented network and the presence of blue and black color
associated with sparse polymorphic vascular structures indicating
invasive nodular melanoma . The
patient was sent to a maxillofacial surgeon for excision, and
histopathological examination revealed a nodular melanoma,
Breslow thickness 2.6 mm.
The diagnosis of a nodular melanoma can be a real challenge.
The reason for this is an insufficiency of clinical and
dermoscopic features for this type of melanoma. Therefore,
from a clinical point of view EFG rule (elevation, firm on
palpation and growth) can be of use in the clinical evaluation
of nodular lesions. From the dermoscopic point of view, a
combination of blue and black colors called blue-black rule
can be of utmost importance in evaluating pigmented or partially
pigmented nodular melanoma. | /content/SkinCancerDataset_LC/SkinCancerDataset_LC/images/301.png |
302 | Dermoscopic examination of nodular part of the lesion
revealed a combination of blue and black colors pointing to a
blue-black rule together with visible hemorrhage in the central
and low part of the lesion (Fig. 25.1b), while flat non-pigmented
part of the lesion revealed a milky red color and
withish lines surrounded by the delicate pigmented network
pointing to the diagnosis of nodular melanoma with superficial
component | /content/SkinCancerDataset_LC/SkinCancerDataset_LC/images/302.png |
303 | Dermoscopic evaluation of the suspected lesion revealed a
blue and black islands of pigmentation in the upper portion
of the lesion, while whitish lines and linear-irregular vessels
were detected on the lower part of the lesion. Described dermoscopic characteristics were in line with
the diagnosis of invasive nodular melanoma. The patent was
urgently sent for surgical excision, and pathohistological
diagnosis revealed a nodular melanoma, Breslow thickness
4.5 mm (Fig. 26.1c). | /content/SkinCancerDataset_LC/SkinCancerDataset_LC/images/303.png |
304 | The dermoscopic evaluation showed arborizing vessels and
blue ovoid nest in the central part of the lesion corresponding
to basal cell carcinoma. However, milky-red color with regression
and linear irregular vessels as well as signs of pigmentation presented by irregularly distributed globules and a discrete pigment
network on the edges of the lesion were detected, excluding
therapy with electrocauterization and sending the patient to
a surgical excision with the suspected diagnosis of hypomelanotic
melanoma (Fig. 29.1). A suspected diagnosis was confirmed
by histopathology, with a Breslow thickness of 1.2 mm. | /content/SkinCancerDataset_LC/SkinCancerDataset_LC/images/304.png |
305 | Diagnosis and Discussion
A clear parallel ridge pattern was observed by dermoscopy at
the periphery of the lesion (Fig. 30.1b), while in the central
part of the lesion a structureless area of brown, black and
white pigmentation was detected (Fig. 30.1c). The patient was
diagnosed with an invasive acral lentiginous melanoma. The
surgical excision was performed, and histopathological examination
revealed acral lentiginous melanoma, Breslow thickness
3.4 mm | /content/SkinCancerDataset_LC/SkinCancerDataset_LC/images/305.png |
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