Cas dermatoscopique
My suspicion
Severe dysplastic nevus - initial melanoma in-situ
In a 33-year-old female patient a known pigmented skin tumour (5x6mm) was observed on her back. She had skin type II, more than 100 small and larger non suspicious nevi, but a melanoma in her own medical history (SSM, tumour thickness 0.32mm, Level II, lower right leg, June 2003).
In dermoscopy a slight asymmetric pigmented tumour with different homogeneous areas was visible. Some irregular slight dots and globules were presented, but no network. In total the tumour had light to dark brown colours. Between 10 and 2 o?clock the homogeneous pigmentation was slightly darker (FotoFinder, 20fold magnification).
Dermoscopy after a six-month period: between 10 and 2 o?clock clearly increasing asymmetric and no more homogeneous pigmentation. Therefore the skin tumour showed an asymmetric change which was only visible in the follow-up (FotoFinder, 20fold magnification).
Histological diagnose
Severe dysplastic nevus
Remarks
Important was the asymmetric change noticed due to the follow-up which led to the correct decision of rapid excision.
Reference
Bauer J, Blum A, Strohäcker U, Garbe C (2005) Surveillance of patients at high risk for cutaneous malignant melanoma using digital dermoscopy. Br J Dermatol 152: 87-92.