At the right earlobe of a 72-year-old female patient a reddish-livid increasing hard swelling tumour with good visible vessels appeared. In 1999 a melanoma with a tumour thickness of 2mm had been operated at this localisation. Two years ago a metastasis of the melanoma was removed and followed by a radiation with altogether 60 Gy. She was skin type II, less than 50 small, non suspicious nevi, seborrheic keratosis and angiomas in clinic and dermoscopy (FotoFinder).

In dermoscopy a reddish-livid coloration at the border and whitish areas at the centre of the tumour were visible (FotoFinder, 20fold magnification).

If the dermoscopic examination would be performed without any pressure on the tumour, reddish-livid coloration with vessels of different sizes were visible. The vessels had the tree-like pattern like a basal cell carcinoma. Further feature were not detectable (FotoFinder, 20fold magnification).

Histology
Dermal metastasis of melanoma with a thickness of 12mm.

Remarks
This case demonstrates very good that too much pressure on a tumour influences clearly the diagnostic value. Thus the vessels are compressed and therefore important information is lost for the examiner.

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