Numerous pigmented lesions on sun-damaged skin : Where is the 'wolf between the lambs'?

摘要

A 64-year-old patient presented with bronzed, sun-damaged skin presented with numerous light and dark brown macules, mainly with sharply demarcated with irregular borders, presente. Dermatoscopy showed a faint, light and dark brown network, fingerprint-like structures and irregular, sharp, moth-eaten borders in most lesions. In contrast, one dark-brown and bluish, asymmetrical flat plaque on the patient's right arm showed blue-grey globules, blue ovoid structures and leaf-like areas. Histology revealed a pigmented superficial basal cell carcinoma. Dermatoscopy allowed filtering out the malignant lesion easily despite the large number of solar lentigines and some melanocytic nevi because of the characteristic dermoscopic criteria and the "ugly duckling sign".