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Three cases of nested melanoma have been documented in detail by Longo and colleagues.1 Clinically, we see flat, asymmetrically shaped lesions with irregular pigmentation, measuring 5 to 10 mm in diameter, on heavily sun-damaged skin, which are highly suggestive of melanoma. Dermoscopy reveals irregular dots and globules, a multicomponent overall structure, irregular blotches, and sometimes atypical pigment network, which are all indicative for melanoma. Confocal microscopy did not add much, revealing the presence of a “clod” pattern made of large compact nests with variable atypia. Taken all together, we would clinically diagnose superficial spreading melanoma in heavily sun-damaged skin.
Garbe C, Metzler G. Nested Melanoma, A Newly Defined Entity. JAMA Dermatol. 2013;149(8):905-906. doi:10.1001/jamadermatol.2013.4305