Peer Reviewed
Perspectives on dermoscopy

A bleeding lesion with a villous surface

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