Melanoma mimicking seborrheic keratosis: An error of perception precluding correct dermoscopic diagnosis Juliana Casagrande Tavoloni Braga, MD, Alon.

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Presentation transcript:

Melanoma mimicking seborrheic keratosis: An error of perception precluding correct dermoscopic diagnosis Juliana Casagrande Tavoloni Braga, MD, Alon Scope, MD, Itay Klaz, MD, Patricia Mecca, MD, Philip Spencer, MD, Ashfaq A. Marghoob, MD Journal of the American Academy of Dermatology Volume 58, Issue 5, Pages 875-880 (May 2008) DOI: 10.1016/j.jaad.2007.12.011 Copyright © 2008 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Clinical image of lesion on initial presentation (A) and on follow-up visit (B). Asymmetric growth of lesion at periphery can be seen (B, black arrows). Polarized dermoscopic image obtained at baseline displays milia-like cysts (C, black arrows) and comedo-like openings (C, white arrows), typical of SK. Although the 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 asterisk) can be appreciated. Thus the lesion at follow-up visit shows multiple dermoscopic features of melanoma. E and F show close-up polarized dermoscopic images of the lesion; labels indicate the same features as in C and D, respectively. Journal of the American Academy of Dermatology 2008 58, 875-880DOI: (10.1016/j.jaad.2007.12.011) Copyright © 2008 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 A, Low power magnification (×40) of lesion, showing acanthosis and interanastomosing rete ridges (black asterisk), orthohyperkeratosis (black arrow), and horn pseudocyst formation (yellow arrow). Presence of melanocytic nests can be readily appreciated (yellow asterisk). B, Higher magnification (×200) of area that shows melanocytic nests in A. Image shows single cell invasion of superficial papillary dermis (black arrow), beneath and adjacent to the comedo like opening (black asterisk), and horn pseudocyst (yellow arrow). Atypical singly disposed melanocytes abound at dermoepidermal junction, as do irregular atypical nests (yellow asterisks). Additionally, some lentigo-like changes are noted in upper left epidermis (black arrowhead). (Hematoxylin-eosin stain.) Journal of the American Academy of Dermatology 2008 58, 875-880DOI: (10.1016/j.jaad.2007.12.011) Copyright © 2008 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 A, 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. B, Higher magnification of atypical vessels at periphery of lesion. C, Higher magnification of pigment network at periphery of lesion. Areas shown in B and C are denoted by rectangles in A. (Original magnification: ×1.5) Journal of the American Academy of Dermatology 2008 58, 875-880DOI: (10.1016/j.jaad.2007.12.011) Copyright © 2008 American Academy of Dermatology, Inc. Terms and Conditions