Perspectives on dermoscopy

A bleeding lesion with a villous surface

Steven Kossard

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Abstract

Seborrhoeic keratoses often lose their characteristic dermatoscopic features, and pale villous projections may be the only clue to the correct diagnosis.

Article Extract

Case presentation

Over a six week period, a 64-year-old man noted an irritated lesion on his anterior chest (Figure 1). The lesion measured 8 mm in diameter and it bled. Dermoscopy revealed an elevated lesion with multiple pale villous projections that were partially obscured by a black eschar. The surrounding skin had a pink homogeneous hue, but there was no evident pigment network (Figure 2). Excision biopsy showed a markedly papillomatous epidermis covered by a loose stratum corneum containing locules of blood. The epidermis was hyperplastic but lacked evident atypia. There was a prominent lymphocytic infiltrate hugging the epidermal junction at the dermal interface (Figure 3).

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