Description: Pigmented lesion on skin above knee. Note the blue clod and the polymorphous vessels arising from the background pigmented lesion.

History: This lesion had changed recently. What do you think it is and do you feel that the information available dermatoscopically was enhanced by using the Automatic light level toggle (single click only) in my Image management programme?
The path report of the initial excision was " A superficial spreading malignant melanoma . The bulk of the melanoma is Level 1 (in situ). There is however a central dermally invasive component ( Level 3, 0.80mm in greatest depth). No tumour infiltrating lymphocytes, no regression."
You have a pink papule arising in a background pigmented lesion. Essentially melanoma until proven otherwise. The dermatoscopy is interesting and to my view superficially misleading. On the non enhanced views it looks like a pigmented BCC but I felt the automatic colour adjust made the dermatoscopic diagnosis easier by highlighting the melanin and the polymorphous vessels.
View the Blog discussion of this case