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Dermoscopic Vascular Patterns in Nodular “Pure” Amelanotic Melanoma

Stefano Cavicchini, MD; Athanasia Tourlaki, MD; Silvia Bottini, MD
Arch Dermatol. 2007;143(4):556. doi:10.1001/archderm.143.4.556.
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Dermoscopic vascular pattern may be essential for the correct diagnosis of completely amelanotic melanomas, which are still a diagnostic challenge because of the lack of pigmentation. Here we illustrate the dermoscopy images of 3 biopsy-proven amelanotic melanomas, all Clark level IV and Breslow depth greater than 4 mm, belonging to different patients (Figures 1, 2, and 3). Milky red globules and/or areas (black arrows) and irregular linear vessels (white arrows) were always detected; hairpin (white arrowheads) and dotted vessels (black arrowheads) were observed in 2 cases; and highly tortuous vessels, a rarely described feature, were found in only 1 case (stars in Figure 1). In conclusion, the milky red globules and/or areas, which correspond to highly vascularized tumor cell nests, together with the irregular linear vessels seem to be the most useful dermoscopic features for the diagnosis of truly amelanotic melanomas, although hairpin, dotted, and highly tortuous vessels should also be considered.

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