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Dermoscopy Patterns of Eczemalike Melanoma

Jason Giacomel, MBBS; Iris Zalaudek, MD; Gerardo Ferrara, MD; Giuseppe Argenziano, MD
Arch Dermatol. 2007;143(8):1073-1087. doi:10.1001/archderm.143.8.1081.
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A melanotic/hypomelanotic melanoma (AHM) may present uncommonly as a scaly and ill-defined reddish patch or plaque, simulating localized eczema or dermatitis.13 Such eczemalike AHM may not be suspected on clinical examination, potentially resulting in a delayed diagnosis and inappropriate treatment. Important clinical clues for AHM are a solitary, continuously enlarging lesion that is unresponsive to topical therapy. Furthermore, dermoscopy may enhance this suspicion by revealing atypical vascular structures, remnants of pigmentation, or nonspecific patterns that bar an accurate diagnosis.3,4 We report a case of AHM, clinically mimicking localized eczema, in which the correct diagnosis and management was facilitated by a suspect clinical history and by dermoscopy.

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Figure 2.

Histopathologic features of the punch biopsy specimen (hematoxylin-eosin for all panels). The melanocytic neoplasm involves the skin from the epidermis to the reticular dermis (A) (original magnification ×25) and is composed of irregularly sized, shaped, and spaced nests (B) (original magnification ×100). Epithelioid melanocytes are highly atypical in both the dermis (C) (original magnification ×250) and the epidermis (D) (original magnification ×250) with no appreciable maturation.

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Figure 1.

A persisting eczemalike amelanotic/hypomelanotic melanoma (AHM) located on the left posterior heel of a 44-year-old woman. A, Clinical view of the AHM presenting as a scaly pinkish plaque. B, Dermoscopic examination shows an overall asymmetric distribution of colors and structures, with multiple, irregularly distributed brown globules (upper and lower aspects of the lesion). Note the homogeneous bluish area intermingled with milky-red globules (circle), groups of dotted vessels at the periphery (left and right sides of the lesion), and regression structures (composed of white scarlike areas and pepperlike granules) at the right upper part of the lesion (original magnification ×10). At higher magnification (inset), atypical (corkscrew) vessels are seen within a milky-red globule (original magnification ×20).

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