PMC2989703_01
(a) Dermoscopic image of nodular pigmented lesion showing a blue gray veil structureless brown areas and dark brown dots in the center (original magnification 30x). (b) RCM image (4 x 4 mm) at dermoepidermal level, showing a general cauliflower architecture highly specific for BCC diagnosis (scale bar: 500 mum). (c) RCM image (0.5 x 0.5 mm, white frame), showing dark silhouettes (yellow arrows) outlined by dark spaces. In the inner portion of them, bright filaments were present (white arrows) (scale bar: 50 mum). (d) Histology showing basaloid nodules in the dermis corresponding to hypopigmented dark silhouettes. Within and outside the tumor nests some melanin was present (H&E section; original magnification x100).
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fig1
Dermoscopy showed blue-white veil, irregularly distributed black-brown dots, and brown structureless areas (Figure 1(a)). In the inner portion of the dark silhouette, it was possible to note the hyperreflective thin dendrites and bright oval structures corresponding to pigmented melanocytes or inflammatory cells on histology (Figure 1(c)).
PMC2989703_02
(a) Dermoscopic image of pigmented nodule exhibiting a bluish veil on the entire lesion and numerous vessels with corkscrew aspect (original magnification 20x). (b) RCM image (4 x 4 mm) imaged at upper dermis level, showing the cauliflower aspect with numerous plump bright cells overlying all lesion area (scale bar: 500 mum). (c) RCM image (0.5 x 0.5 mm) showing reflective aggregates of tightly packed cells with peripheral palisading (white arrow) surrounded by dark clefts. Inside the tumoral nest bright filaments and dots were present (yellow arrowhead) (scale bar: 50 mum). (d) Histology showing basaloid tumoral nests enclosed by connective tissue stroma. Melanin was present inside the tumoral nests and also in the surrounding stroma where numerous melanophages were detected (H&E section; original magnification x100).
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fig2
Inside the tumoral nest bright filaments and dots were present (Figure 2(c)). Melanin pigment was present either as melanophages or melanocytes entrapped in the basaloid nests (Figure 2(d)).
PMC2989703_03
(a) Dermoscopic image of nodular pigmented lesion with an atypical globular pattern, structureless dark brown areas, irregular brown dots in the center of the lesion (white arrowhead), and a blue-white veil (original magnification 50x). (b) RCM image (0.5 x 0.5 mm) acquired at stratum granulosum-spinosum, showing broadened honeycombed (scale bar: 50 mum). (c) RCM image (0.5 x 0.5 mm), at dermal level, showing markedly pleomorphic cells distributed in sheet-like structures in the dermis and numerous bright dots. Inside the tumoral nested proliferation, new-born vessels are present (yellow arrows) (scale bar: 50 mum). (d) Histological image showing an overview of the nodular melanoma with Breslow thickness of 6.5 mm (H&E section; original magnification x400).
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fig3
Dermoscopy showed an atypical globular pattern, structureless dark brown areas, irregular brown dots in the center of the lesion, and a blue-white veil (Figure 3(a)). Markedly pleomorphic cells with bright cytoplasm and dark nuclei are distributed in sheet-like structures in the dermis, numerous bright dots representing inflammatory cells overlying all lesion and enlarged vessels (Figure 3(c)). The lesion was a melanoma with a Breslow thickness of 6.5 mm (Figure 3(d)).
PMC2989703_04
(a) Dermoscopy showed structureless areas with blue hue and a globular pattern. Ulceration was present in the center of the nodule (original magnification 30x). (b) RCM image (0.5 x 0.5 mm) at dermal level, showing pleomorphic small cells (yellow arrow) arranged to form a cerebriform nests delimitated by fibrous septa (scale bar: 50 mum). (c) RCM image (0.5 x 0.5 mm) at dermal level, showing an enlarged new-born vessel with a prominent blood flow (yellow arrow) (scale bar: 50 mum). (d) Histology showing a solid proliferation of atypical melanocytes in which new-born vessels can be recognized (H&E section; original magnification x100).
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fig4
Ulceration was present in the center of the nodule (Figure 4(a)). Numerous atypical cells with the tendency to form aggregates with cerebriform aspect were present in the dermis (Figure 4(b)). The lesion showed a marked and increased vascularization with enlarged new-born vessels (Figure 4(c)).