Blue-gray globules

A 67-year-old woman consulted for this lesion on her back. Dermoscopy revealed blue-gray globules (rectangle) and some arborizing vessels (arrows) confirming easily the diagnosis of basal cell carcinoma.

Blue-gray globules are a pathognomonic sign  in pigmented basal cell carcinoma. 

They are often associate with other basal cell carcinoma specific criteria, as leaf-like structures,

spoke-wheel areas and  large blue-gray ovoid nests.

Arborizing tree vessels

A 54-year-old woman consulted for this small pink lesion on her scalp (parietal area)

Dermoscopy revealed many arborizing vessels in favour of a basal cell carcinoma.

The lesion was excised and pathology confirmed the clinical and dermoscopic diagnoses.

Seborrheic keratosis

A 50-year-old woman consulted for an enlarging and pruritic lesion on her back.

This pigmented lesion was characterized in dermoscopy by:

• absence of pigment network
• sharp demarcation
• presence of milia-like cysts
• comedo-like openings

This dermoscopic presentation was typical of a seborrheic keratosis.

Red lacunes on the ridges

A 28-year old-woman consulted for this dark red acral lesion present since early childhood.

Dermoscopy revealed many red saccules (or lacunes) located on the ridges with a parallel pattern.

This dermoscopic feature was in favor of an hemangioma or an hemolymphangioma

Plantar nevus

A 25-year-old woman consulted for a pigmented lesion on her right foot.

Dermoscopy revealed a parallel furrow pattern and a whitish structureless area.

On the middle of this structureless area a keratotic lesion was noticed in favor of a callus.

An excision was performed and pathology revealed a benign melanocytic nevus.

The structureless area was caused by the chronic friction of this nevus against shoes.

Whitish area

A 17-year-old girl presented a pigmented lesion with a lateral  depigmentation.

Dermoscopy  revealed a globular pattern associated with a whitish structureless area. On this whitish area some vessels were observed. There were no signs of peppering.

This lesion was excised and pathology revealed a benign dermal melanocytic nevus with a fibrous involution.

Whitish structureless area can be observed in:

• fibrous involution
• after traumatism
• in case of regression (with peppering)

Lattice-like pattern

A 14-year-old girl consulted for this small plantar nevus.

Dermoscopy revealed a typical lattice-like pattern which is a subtype of parallel furrow pattern in favour of a benign acral plantar nevus.

Other cases of acral nevi:

1  2  3  4  5  6  7  8  9  10  11  

Acral melanocytic nevus

A 48-year-old woman consulted for this pigmented lesion on her 5th right finger present since early childhood. 

Dermoscopy revealed a parallel furrow pattern and in some areas a lattice-like pattern.

The dermoscopic features were in favor of a benign acral nevus.

A regular yearly follow-up was planned.

In parallel furrow pattern, the pigmentation follows the sulci at the difference of parallel ridge pattern where the pigmentation follows the cristae.

In Acral melanocytic nevi, 3 types of patterns can be observed:

• parallel furrow pattern
• lattice-like pattern
• fibrillar pattern

Parallel ridge pattern are typical of acral melanomas but can be observed in other cases:

• milk-line nevus
• subcorneal hemorrhages (talon noir)

Other cases of acral nevi:

1  2  3  4  5  6  7  8  9  10  11  

Leaf-like structures

A 92-year-old woman presented a red tumor on her neck.

Dermoscopy revealed many brown structures with a leaf-like configuration located at the periphery of the lesion. This was typical of leaf-like structures, also called maple leaf-like areas in the first publications.

Leaf-like structures are quite exclusively found in basal cell carcinomas but have also been reported in featureless melanomas.

Other cases of basal cell carcinomas: 

1 2 3 4 5 6 7 8 9  10 11 12 13 14 15 16 17 18 19 20 21

Hairpin-like vessels and seborrheic keratoses

These 2 cases of seborrheic keratoses are dysplaying hairpin vessels:

Case 1: clinical view

Case 1: dermoscopic view: numerous hairpin blood vessels 

Case 2: dermoscopic view: rare hairpin vessels

Hairpin vessels can be found in:

• seborrheic keratoses (fine, often surrounded by a hypopigmented halo)
• Melanoma (irregular)
• Spitz nevi
• keratoacanthomas