On the left chest of 37-year-old male patient a rapid growing tumour appeared, not homogeneous reddish and in part whitish, exophytic and nearly symmetric. No trauma, no former surgery and no noticed inflammation occurred before. He was skin type II, few non suspicious melanocytic nevi in clinic and dermoscopy. No melanoma history by himself and his family.

In dermoscopy an asymmetric tumour appeared: ¾ with reddish colour, ¼ nearly complete whitish. In the reddish part a centre with numerous vessels was visible, vessels with different lumens but identical in the vessel pattern.

The whitish part revealed no vessels. At the lower part and inside of the tumour a distinct brownish pigmentation was visible. At the upper part and outside of the tumour also a brownish, not sharp pigmentation without any pattern was found.

Histology
Pyogenic granuloma

Remarks
Due to the clinic and dermoscopy two differential diagnoses must be considered: the nodular amelanotic melanoma and the pyogenic granuloma. In this case the nodular amelanotic melanoma must be excluded due to the history, clinic and dermoscopy. At present no save dermoscopic classification is available to differentiate between these two diagnoses.

References
1. Argenziano G, Zalaudek I, Corona R et al. (2004) Vascular structures in skin tumors: a dermoscopy study. Arch Dermatol 140: 1485-1489

2. Zaballos P, Salsench E, Puig S, Malvehy J (2007) Dermoscopy of pyogenic granulomas. Arch Dermatol 143: 824

3. Menzies SW, Kreusch J, Byth K et al. (2008) Dermoscopic evaluation of amelanotic and hypomelanotic Melanoma. Arch Dermatol 144:1120-1127