Yes. Breaking Bad II: Dermoscopy of Pink-ish Things. Does it Fit? Yes 6/17/2018. Yes. Joslyn Kirby, MD, MS, MEd

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1 Breaking Bad II: Dermoscopy of Pink-ish Things Joslyn Kirby, MD, MS, MEd Yes Observe Yes Step 2. Fit a Benign Nevus Pattern? Does it Fit? Step 1: Melanocytic? pigment network, globules, homogeneous? No Yes Melanoma Biopsy/Excise Step 3. Are there Melanoma Features? No No Step 2. Structures seen in DF, BCC, SK, Angioma, SCC? Concerning: Excise or Short-term monitoring Copyright restrictions may apply. Marghoob, A. A. et al. Arch Dermatol 2010;146:

2 Benign Pink (Vascular) Patterns: The Goal is Biopsy Benign vs. Concerning Pink (Vascular) Patterns Vascular structures on Dermoscopy Clinical entity Sebaceus Hyperplasia Dermal nevus Spitz nevus Pyogenic granuloma Clear cell acanthoma Dermatofibroma Seborrheic Keratosis BCC SCC Amelanotic Melanoma Dermatoscopic findings Yellow globules, crowning vessels Comma vessels, pigment network Dotted vessels throughout Homogenous red w/ collarette Pink with String of (Red) Pearls Stellate scar-like center +- peripheral pigment network Gyri/sulci, Coral/fingerprint Arborizing vessels, white lines Hairpin vessels, coiled vessels, scale Red globules, dotted vessels, serpentine, corkscrew, 2+ 2

3 Which of these pink patterns is a benign pattern? A B C D Which of these pink patterns is a benign pattern? A B C D 54-year-old woman with spot for years 3

4 BCC Findings Scaling & Erosion Leaf-like Structures Arborizing Vessels Blue Grey Ovoid Nests Dermal nevus vs BCC Blue grey ovoid nests, Arborizing vessels 4

5 BCC vs SK Once BCC d Twice shy 5

6 Seb hyp vs BCC Crowning vessels looping over globules Arborizing vessels (broad to fine), starts at lesion edge, crosses midline) Seb hyp vs BCC vs SCC Crowning vessels looping over globules Arborizing vessels (broad to fine), starts at lesion edge, crosses midline) Porokeratosis Blanching erythema, Scale Hyperkeratotic coronoid lamella 6

7 I ve got this new spot on my leg Cortaid didn t do much SCC vs Psoriasis Dotted vessels and scale 40-year-old man with tender pink bump on his arm. It s been there a while. Unsure of changes, but it s asymptomatic. 7

8 BCC? Nevus? SCC? 8

9 Amelanotic Melanoma? Steglich RB, et al.an Bras Dermatol. 2012;87(6):920. What do you think? 9

10 Amelanotic melanoma Amelanotic melanoma dermoscopymadesimple.blogspot.com/ Which pink pattern predominates in this lesion? 10

11 36-year-old woman with new spot on her shin Zaballos P, et al. Arch Derm. 2008;144(1): year-old woman with 15 mm enlarging itchy pink growth on the left thigh for 2 years. 11

12 What structure is present? White Shiny Lines (Chrysalis) seen in: Amelanotic melanoma and BCC Tracey N. Liebman, BA; Harold S. Rabinovitz, MD; Yevgeniy Balagula, MD; Natalia Jaimes-Lopez, MD; Ashfaq A. Marghoob, MD 40 year-old woman with a new growth on her left arm 12

13 Critical eye: DF vs Atypical Spitz nevus Spitz Epithelioid nevi Reed All red dots Starburst Cherry Angioma vs Evil Twin Targetoid hemosiderotic hemangioma: melanoma mimicker 13

14 Angioma vs Hemosiderotic hemangioma 55-year-old woman with sudden onset new papule A 14- year old boy with a tender red papule on the left lateral 5 th finger What is your clinical diagnosis? 14

15 Clinical Comparison Acanthoma vs Pyogenic granuloma Homogenous pink with red dots in STRING OF PEARLS Homogenous red area with white collarette One more case 15

16 BCC? Dermal Nevus? Senel E. IJDVL. 2011;77:16. Chen LC, et al. JAMA Derm. 2015;151:715. Jalilian C, et al. BJD. 2013;169:294 Which pink pattern predominates in this lesion? Comma vessels Dotted vessels Serpentine pattern String of pearls pattern Which pink pattern predominates in this lesion? Comma vessels Dotted vessels Serpentine pattern String of pearls pattern 16

17 Which pink pattern predominates in this lesion? Comma vessels Dotted vessels Glomeruloid pattern String of pearls pattern Which pink pattern predominates in this lesion? Comma vessels Dotted vessels Glomeruloid pattern String of pearls pattern Pink (Vascular) Patterns: The Goal is Biopsy 17

18 Vascular structures on Dermoscopy Clinical entity Sebaceus Hyperplasia Dermal nevus Spitz nevus Pyogenic granuloma Clear cell acanthoma Dermatofibroma Seborrheic Keratosis BCC SCC Amelanotic Melanoma Dermatoscopic findings Yellow globules, crowning vessels Comma vessels, pigment network Dotted vessels throughout Homogenous red w/ collarette Pink with String of (Red) Pearls Stellate scar-like center +- peripheral pigment network Gyri/sulci, Coral/fingerprint Arborizing vessels, white lines Hairpin vessels, coiled vessels, scale Red globules, dotted vessels, serpentine, corkscrew, 2+ 18