An atypical pigmented lesion

Claudia Costa1, Franco Palmisano1, Massimiliano Scalvenzi1

1 Department of Dermatology, University of Naples Federico II, Naples, Italy

Citation:  Costa C, Palmisano F, Scalvenzi M. An atypical pigmented lesion. Dermatol Pract Concept. 2014;4(2):13.

Copyright: ©2014 Costa et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Corresponding author:  Massimiliano Scalvenzi, via Pansini 5, 80129 Naples. Italy. Email:

The patient

A 61-year-old white man presented with an asymptomatic brown-red nodular lesion located on his back. The patient reported the lesion had been present for years (Figure 1). He had no previous skin cancers and there was no family history of melanoma.

On dermoscopy, the lesion showed a multicomponent pattern, characterized by blue-gray dots, globules and a network disposed centrifugally at the periphery with a polymorphous vascular pattern  and chrysalis structures centrally (Figure 2).

An excisional biopsy was performed with 2 mm margins.

The diagnoses proposed to the pathologist included basal cell carcinoma and melanoma.

The morphological field (Figure 3) shows a neoplasia with dermal dislocation, composed of a well-defined nodule in the middle surrounded by small nests in which multiple keratinic cysts can be identified (red arrows). Some of them are locus of dystrophic calcification (green arrows). The neoplasia is composed of basaloid cells with mild cytology without acceptable mitotic activity.

What is your diagnosis?

Please send your answer to The first correct answer will receive a DL3N hand dermoscope [cordially sponsored by 3GEN]. The case and the answer to the question will be presented in the next issue of Dermatology Practical and Conceptual.