Small moles may have complex features under dermoscopy and may require excisional biopsy for accurate diagnosis, but they can usually be monitored for stability.
A 34-year-old woman noted the appearance of a 2 mm firm dark mole below her left eye (Figure 1). This had appeared 18 months previously and had remained stable in size. Dermoscopy revealed a deeply pigmented lesion which had an irregular border with branched pigmentation and small peripheral dark dots as well as an overlying patchy blue–grey veil (Figure 2). Excision biopsy showed isolated darkly pigmented melanocytes and nests at the epidermal junction as well as pigmented melanocytes forming a spindle cell nodule that extended into the deep dermis (Figure 3).