PMC4212671_01
Asymmetrical lesion with irregular borders on the sternal region. It was barely palpable and composed of brown areas and cutaneous paler regions of regressive origin.
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F1
Based on the clinical features, a tentative diagnosis of melanoma was made (Figure 1).
The dermoscopic evaluation revealed the presence of a polymorphic pattern composed by a pigment network, asymmetrical in its distribuition (black arrows), globular structures together with regressive white areas (blue arrow); an atypical vascular pattern (red arrows) could be observed within or near the whitish areas. These dermoscopic structures supported the diagnosis of melanoma. Rare globular structures only in retrospect can be interpreted as the blue-grey ovoid nests sometimes observed in basal cell carcinoma (blue square); also the short and fine telangectasias and shiny white to red areas in the lower portion of the tumour (yellow arrow) can be referred to a basal cell carcinoma while the homogeneous brown pigmentation on the centre of the lesion is attributable to the intradermal naevus (green arrow).
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F2
The lesion was examined dermoscopically (Figure 2).
Multiple areas of basaloid proliferation and early superficial basal cell carcinoma (B,C,E; red arrows) are mixed with Hutchinson's lentigo with focal intraepithelial (in situ) melanoma (A,C,D,E; blue arrows), strongly immunoreactive with HMB45. A residual dermal naevus was also detectable in several sections of the same lesion (F, yellow circle).
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F3
Histopathological examination showed, within the epidermis, focal areas of early basal cell carcinoma, mostly superficial as well as areas of basaloid proliferation (Figures 3B,C,E). Intermixed to these areas, we can also observe an atypical lentiginous melanocytic proliferation with multifocal tendency to intraepithelial growth (Hutchinson's freckle-early in situ melanoma, Figure 3A,C,D,E). Images of a residual dermal naevus were also present in several sections of the lesion (Figure 3F).