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 Neoplasms: Subpatterns of Melanoma—Degrees of Malignancy. Arch Dermatol. 2005;141(3):406. doi:10.1001/archpedi.161.4.356
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