The dermatoscope is a source of endless wonder. Here are two cases seen in the past week.
1. Congenital Nevus of Special Site
This 5 month old bi-racial (Black/Caucasian) foster infant was noted to have a slowly enlarging pigmented lesion
in his left crural fold since around one month of age.
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| photo taken by Dr. Yoon Cohen |
Question/Comment: Would anyone do anything other than follow this child? Is the gray veil significant? The symmetrically distributed brown clods are to my mind markers for a benign growing nevus (cobblestone pattern). There is no pertinent literature about growth in small congenital nevi. Melanoma, in this age group and ethnicity, is exceedingly rare.
2. Unusual Subungual Hematoma
A 72 yo woman noted nail pigmentation that appeared shortly after knee
replacement surgery. I do not know if she had been anticoagulated after surgery, but the information would help. The subungual color under the cuticle may be an example of a "pseudo-Hutchinson sign."
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| 1 month follow-up |
Question/Comment: The fact that this appeared shortly after surgery strongly suggests trauma rather than neoplasia. If the patient was anticoagulated during surgery, that would be one more helpful historical fact. The pattern of the long band could be called the "tadpole sign" -- I wonder if it is specific for subungual hematoma.
References:
1. Precursors to melanoma and their mimics: nevi of special sites.
1. Precursors to melanoma and their mimics: nevi of special sites.
Elder DE. Precursors to melanoma and their mimics: nevi of
special sites. Mod Pathol. 2006 Feb;19 Suppl 2:S4-20. Free Full Text.
2. Dermnet.nz.org has good sections on dermtoscopy: Introduction to Dermatoscopy Dermatoscopic Features 3. Overview of Nail Dermatoscopy
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