Skip to Main Content
×close section menu
Jump to a Section

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 32-year-old man has many small banal appearing nevi on his trunk and extremities. A nevus on his left arm looked different than the others.

  1. This is a melanocytic lesion because there is a pigment network.

  2. It has a reticular global pattern.

  3. There is symmetry of color and structure.

  4. A uniform, regular pigment network fills most of the lesion.

  5. Multifocal hypopigmentation and irregular pigment network diagnose a moderately dysplastic nevus.

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

  • Regular pigment network (black boxes)

  • Mildly irregular pigment network (white boxes)

  • Multifocal hypopigmentation (black arrows)

ANSWERS

Answers: 1,2,3,4

Discussion:

  • Melanoma is in the clinical differential diagnosis because there are slightly irregular borders, several dark colors, and it is an “ugly duckling.”

  • One will not see the entire picture until the lesion is examined with dermoscopy. It could have looked much worse!

  • The “ugly duckling” is a pigmented skin lesion that clinically and/or dermoscopically is different from the other lesions on a patient.

  • An “ugly duckling” lesion is a red flag for concern; however, it is not always high risk.

  • The dermoscopic picture seen here should give one reassurance that this is not a melanoma.

  • By definition this is the reticular global pattern because the lesion is made up of pigment network.

  • There are foci of mildly irregular pigment network with broadened, branched, and broken up line segments.

  • Irregular pigment network is not always associated with high-risk pathology.

  • Multifocal hypopigmentation and irregular pigment network can be found in dysplastic nevi.

  • The hypopigmentaion could represent normal skin that commonly is found in melanocytic nevi.

  • There are no well-developed melanoma-specific ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.