JAMES M.GRICHNIKMD, PhD
There appears to be a gradient in the severity of dysplastic (atypical/Clark) nevi. This gradient also appears to continue through early melanomas and may be represented by the complexity of dermoscopic patterns. The lesions presented are from the back of a 37-year-old woman revealing a predominant brown reticular pattern with prominent but regular network and an asymmetric area of regression (Figure 1); the back of a 55-year-old man exhibiting an asymmetric reticular pattern with atypical network and multiple areas of regression (Figure 2); the thigh of a 33-year-old man showing asymmetry of colors and structures, atypical network, streaks, irregular dots/globules, and atypical vascular pattern in the center (Figure 3); and the back of a 64-year-old man exhibiting asymmetry of multiple colors and structures, irregular dots/globules, streaks, black blotches, milky-red areas, and large blue-white structures (Figure 4). Respectively, the lesions were interpreted as melanoma in situ, early invasive melanoma of 0.3-mm thickness, melanoma of 0.8-mm thickness, and melanoma of 1.1-mm thickness. Thin melanomas may exhibit brown to black coloration, while thicker lesions may include red and blue coloration as well as more structural abnormalities.
Argenziano G. Dermoscopy of Melanocytic NeoplasmsSubpatterns of Melanoma—Degrees of Malignancy. Arch Dermatol. 2005;141(3):406. doi:10.1001/archpedi.161.4.356