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GENERAL INSTRUCTIONS

General Instructions:

You will find a list of True/False statements following each case history. Select any statements, which you believe to be true. There may be one, more than one or no true statements for any given case. Choose the correct risk, diagnosis and disposition for each case. Then, turn the page to find a detailed discussion and pearls for each case.

CASE 1

CASE 1 HISTORY

A 29-year-old man has had a nonhealing itchy spot on his scalp for 1 year.

  1. Pigmented pseudofollicular openings diagnose a pigmented seborrheic keratosis.

  2. Irregular dark dots and globules diagnose a melanocytic lesion.

  3. Irregular dark dots and globules of a melanocytic lesion and pigmented pseudofollicular openings of a seborrheic keratosis are in the dermoscopic differential diagnosis of the dark round structures.

  4. Asymmetry of color and structure plus the multicomponent global pattern help diagnose a pigmented seborrheic keratosis.

  5. Once it is determined to be a melanocytic lesion and not a seborrheic keratosis, with several well-developed melanoma-specific criteria it is easy to diagnose a melanoma.

RISK

  • ☐ Low

  • ☐ Intermediate

  • ☐ High

DIAGNOSIS

  • ☐ Nevus

  • ☐ Seborrheic keratosis

  • ☐ Basal cell carcinoma

  • ☐ Vascular

  • ☐ Dermatofibroma

  • ☐ Squamous cell carcinoma

  • ☐ Melanoma

  • ☐ Other

DISPOSITION

  • ☐ No intervention

  • ☐ Follow-up

  • ☐ Histopathologic diagnosis

RISK

  • ☐ Low

  • ☐ Intermediate

  • ☑ High

DIAGNOSIS

  • ☐ Nevus

  • ☐ Seborrheic keratosis

  • ☐ Basal cell carcinoma

  • ☐ Vascular

  • ☐ Dermatofibroma

  • ☐ Squamous cell carcinoma

  • ☑ Melanoma

  • ☐ Other

DISPOSITION

  • ☐ No intervention

  • ☐ Follow-up

  • ☑ Histopathologic diagnosis

DERMOSCOPIC CRITERIA

  • Asymmetry of color and structure (+)

  • Multicomponent global pattern (1,2,3,4)

  • Irregular large dark dots and globules (yellow boxes)

  • Irregular small dots and globules (red circles)

  • Irregular dark blotch (white arrows)

  • Regression (white stars)

  • Circle within a circle (red arrows)

  • Multiple colors

ANSWERS

Answers: 2,3,5

Discussion:

  • Clinically but not dermoscopically a seborrheic keratosis is in the differential diagnosis.

  • Dark dots and globules diagnose a melanocytic lesion.

  • The dots and globules are irregular because they are of different sizes and shapes and are asymmetrically located in the lesion.

  • There is asymmetry of color and structure.

    • The left side of the lesion is not a mirror image of the right side.

    • The lower half of the lesion is not a mirror image of the upper half.

  • The global pattern is multicomponent.

    • More than three different areas within the lesion.

  • Bluish-white color is always a red flag for concern.

  • It is not the classic bluish-white veil/veil.

    • Irregular homogeneous blue ...

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