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Δερματοσκόπηση > Step 2: Methods to DD btw melanoma & benign melanocytic nevi > Flashcards

Step 2: Methods to DD btw melanoma & benign melanocytic nevi Flashcards

1
Q

Colors in benign lesions vs melanoma

A

1-2

vs

+3

5-6 colors => 95% specificity for melanoma

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2
Q

What colors have the greatest impact on melanoma dx?

A
  • Red
  • White
  • Blue/gray

Much more suspicious than brown

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3
Q

Red color

vs

Black

vs

White

vs

Gray

A

Hb in the skin

vs

melanin in stratum corneum or epidermis

vs

fibrosis or hyperkeratosis

vs

melanin in papillary dermis

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4
Q

Comma vessels are ass/w?

A

Benign (intradermal) nevi

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5
Q

Dermoscopic equivalent of ^blood volume within a lesion

A

Milky red areas

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6
Q

Gray colored granularity in benign vs malignant lesions

A

< 10% of lesion surface area(LSA)

vs

> 50%

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7
Q

Melanin located in stratum corneum vs below stratum corneum

A

Can be tape stripped off

vs

cannot

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8
Q

Tape stripping method

A
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9
Q

Blotches

vs

irregular black dots

in melanoma correspond to?

A

melanin in all layers of the epidermis and dermis

vs

pagetoid spread

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10
Q

What does pagetoid spread mean?

A

“upward spreading” of abnormal cells in the epidermis

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11
Q

Characteristic color of benign melanocytic lesions

A

Light brown

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12
Q

Light brown color

+

atypical vessels

should raise suspicion for?

A

Hypomelanotic melanoma

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13
Q

MC dermoscopic manifestation of melanoma in fair-skinned individuals

A
  • Few colors & structures
  • Light brown color
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14
Q

Name the dermoscopic melanoma-specific structures

A
  • Atypical pigment network
  • Negative network
  • Irregular streaks (radial streaming, pseudopods)
  • Atypical dots & globules
  • Blue white veil (BWV)
  • Chrysalis-like structures
  • Regression structures
  • Atypical vessels
  • Atypical blotch
  • Peripheral brown structureless areas
  • 5-6 colors
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15
Q

Which of the melanoma specific structures has the highest OR?

A

Peripheral brown structureless areas

28 (!!)

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16
Q

Pigment network in

benign nevi

vs

melanoma

A
  • Relatively uniform in thickness, color
  • Thinning at the periphery

vs

  • heterogeneous
  • color variegation
  • abrupt cutoff at periphery
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17
Q

Define negative network

A

serpiginous interconnecting hypopigmented lines that surround irregularly shaped pigmented structures

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18
Q

Negative network DDx

A
  • Congenital nevi
  • Acquired nevi (eg, Spitz)
  • Melanoma
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19
Q

Negative network

benign lesions

vs

melanoma

A
  • symmetrically distributed
  • involves ENTIRE lesion

vs

  • asymmetrically distributed
  • focally within the lesion
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20
Q

Lesion with regular streaks in an adult. Management?

A

Excisional biopsy

bcz some melanomas present with relatively regular streaks

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21
Q

MC types of melanoma in childhood(rare) ?

A

Nodular +/- amelanotic

( thus they do not display any streaks)

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22
Q

Lesions with streaks in childhood, management?

A

Closely monitored or excised

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23
Q

Blue white veil over a flat or raised part of the lesion, corresponds with regression?

A

Flat

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24
Q

Regression structures include?

A
  • Blue-white veil over flat part of lesion
  • Peppering/granularity
  • Scar-like depigmentation
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25
Q

Regression structures seen in benign lesions vs melanoma

A

< 10% of LSA

vs

> 50%

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26
Q

Homogeneous blue-white veil in entire lesion

vs

homogeneous BWV in central part

vs

Irregular BWV in melanocytic lesion

A

Blue nevus

vs

combined nevi, Spitz

vs

melanoma

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27
Q

Chrysalis-like structures DDx

A
  • Melanoma
  • Spitz nevi
  • BCC
  • Dermatofibroma
  • LPLK
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28
Q

Regular vs irregular blotches

A
  • Symmetrically in the center
  • can be stripped off
  • black uniform color, “lamella”

vs

  • located off center
  • cannot be stripped off
  • multiple shades of color
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29
Q

Peripheral brown structureless areas correlate with?

A
  • Flattening of DEJ
  • Presence of pagetoid cells
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30
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • Multiple colors ( “chaos”)
  • atypical pigment network
  • Irregular dots & globules
  • irregular blotch
  • regression structures
  • atypical vessels
  • milky red areas

Melanoma

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31
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • One color ( light brown)
  • Typical pn
  • Few typical globules

Benign nevus

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32
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • Comma shaped vessels

Benign intradermal nevus

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33
Q

Describe the major dermoscopic finding in this lesion

Dx?

A
  • Polymorphous vessels
  • Milky red areas

Hypomelanotic melanoma

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34
Q

Describe the major dermoscopic findings in this lesion

Dx?

A

Extensive regression with:

  1. granularity/peppering
  2. scar-like depigmentation
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35
Q

How to differentiate BWV from chrysalis-like structures

A

BWV much more evident in NPD

vs

Chrysalis in PD

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36
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • Multiple colors
  • Atypical pn ( thick lines, small, holes, abrupt cutoff periphery)
  • Irregularly distributed streaks & globules
  • Regression structures
  • Chrysalis

Melanoma

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37
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • Atypical dots & globules
  • Atypical blotches
  • multiple colors

Melanoma

arrow corresponds to pagetoid cells & nests in epidermis

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38
Q

Describe the major dermoscopic finding in this lesion

Dx?

A
  • Typical pn
  • One color, (light brown)

Benign nevus

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39
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • Atypical pn
  • Peripheral brown structureless area

Melanoma

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40
Q

Describe the major dermoscopic finding in this lesion

Dx?

A

Negative network centrally

Benign nevus

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41
Q

Describe the major dermoscopic finding in this lesion

Dx?

A

Focal negative network (lower part)

Melanoma

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42
Q

Highly suggestive of Spitz/Reed nevus?

A

Streaks around the entire perimeter

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43
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • 2 colors, black/brown
  • Central blotch
  • Regular peripheral streaks & globules

Spitz/Reed nevus

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44
Q

Describe the major dermoscopic finding in this lesion

Dx?

A

Focally distributed streaks

Microinvasive melanoma

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45
Q

Describe the major dermoscopic finding in this lesion

Dx?

A
  • Typical pn
  • Black dots regularly distributed

Benign nevus

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46
Q

Describe the major dermoscopic finding in this lesion

Dx?

A

Typical globular pattern throughout the lesion

Benign nevus

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47
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • Peripheral pn
  • Central globules

Benign nevus

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48
Q

Describe the major dermoscopic finding in this lesion

Dx?

A

Peripheral rim of globules

Benign nevus

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49
Q

Identify the most prominent dermoscopic finding in image A vs B

Dx? (Same lesion)

A

A) NPD: Blue-white veil

vs

B) PD: Chrysalis-like structures

Melanoma

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50
Q

Describe the major dermoscopic finding in this lesion

Dx?

A
  • Central black blotch, “lamella”
  • Typical pn

Benign nevus

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51
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • Central structureless area
  • Peripheral pn

Benign nevus

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52
Q

Describe the major dermoscopic finding in this lesion

Dx?

A

Peripheral brown structureless area

Melanoma

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53
Q

Which one has better diagnostic accuracy:

analysis-based algorithms

vs

pattern analysis

A

Pattern analysis (slightly better)

Usage of both methods optimizes diagnostic outcome

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54
Q

Asymmetry is a prerequisite for melanoma dx

T/F ?

A

False

Some melanomas may manifest dermoscopic symmetry

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55
Q

Dermoscopic “definition” of melanoma

A
  • Lesions that deviate from benign nevus patterns
  • Manifest at least 1 out of 10 melanoma-specific structures

Melanoma until proven otherwise

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56
Q

Schematic drawings of the 10 benign nevus patterns

A
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57
Q

Features of diffuse reticular pattern

A
  • Diffuse homogenous network
  • uniform thickness, color of network lines
  • Network fading at periphery
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58
Q

Diffuse reticular pattern is MC seen in..?

A
  • Acquired nevi, individuals with darker phenotype
  • Congenital nevi, > lower extremity
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59
Q

Features of patchy reticular pattern

A
  • Focal patches of homogeneous network
  • surrounded by homogeneous structureless areas
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60
Q

Patchy reticular pattern is MC seen in…?

A
  • Acquired nevi, torso
  • Superficial congenital nevi, lower extremity
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61
Q

Features of peripheral reticular with central hypopigmentation

A
  • uniform network at the periphery
  • central homogenous, hypopigmented, structureless area
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62
Q

Features of peripheral reticular pattern with central hyperpigmentation

A
  • uniform network at the periphery
  • central homogenous, hyperpigmented structureless area or blotch
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63
Q

Peripheral reticular pattern with central

hyperpigmentation

vs

hypopigmentation

is MC seen in?

A

Acquired nevi in:

dark skin phenotype

vs

fair skin

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64
Q

Features of homogeneous pattern

A
  • diffuse homogenous structureless pattern
  • +/- few globules
  • +/- small network fragments

N.B: amelanotic & hypomelanotic melanomas can manifest in a similar manner; however, most melanomas will also reveal atypical blood vessels +/- crystalline structures

65
Q

Define this pattern

MC seen in..?

A

Peripheral reticular with central globules

Congenital nevi

66
Q

Typical pattern of Spitz nevi

A

Starburst pattern with streaks

67
Q

Features of peripheral globular pattern with central network

A
  • central component: reticular or homogeneous
  • When 1 row of uniform globules around the entire perimeter => actively growing nevus ( not yet undergone senescence)
  • When > 2 rows => Starbust pattern
68
Q

Define this pattern

MC seen in…?

A

Globular

Congenital nevi

69
Q

Define the 2-component pattern, give examples

A
  • Half of lesion manifests one pattern,
  • the other half a different one
  • Examples:
  1. reticular-globular
  2. reticular-homogenous
  3. globular-homogenous
70
Q

Define multicomponent pattern

A

Two definitions (only the 1st applies for benign nevi)

  1. Organized +/- symmetrically distributed typical dots/globules, typical network, homogenous areas. One axis of symmetry
  2. Symmetrically distributed globules, network, blotches, dots, veil, regression structures, +/- structureless
    areas​. >3 structures are required to classify the lesion as multicomponent
71
Q

Schematic drawings of a few malignant patterns

A
72
Q

Atypical pn histologically correlates with…?

A

Atypical lentiginous or nested melanocytic proliferation along the DEJ

73
Q

Streaks (radial streaming, pseudopods) histologically correlate with…?

A

Confluent junctional nests of melanocytes at the periphery.

This corresponds to the radial growth phase of the melanoma

74
Q

Negative network histologically correlates with…?

A
  1. Thin elongated rete ridges together with large tubular melanocytic nests within a widened papillary dermis
  2. Bridging of adjacent rete ridges
  3. Nests surrounded by a fibrotic stroma
75
Q

Chrysalis/crystalline histologically correlates with…?

A

remodeled or new dermal collagen

76
Q

Atypical dots & globules histologically correlates with…?

A

Junctional or dermal nests of melanocytes

dots can also represent pagetoid nests

77
Q

Irregular blotches histologically correlates with…?

A

Melanin pigmentation throughout the epidermis or dermis or both

78
Q

Blue-white structures over raised areas histologically correlate with…?

A

Compact orthokeratosis overlying melanophages, melanocytes, or free melanin in the dermis

79
Q

Blue-white structures over flat areas histologically correlate with…?

A

Fibrosis within the papillary dermis and melanosis

80
Q

Atypical vascular structures histologically correlate with…?

A

Tumor-induced neoangiogenesis

81
Q

Peripheral brown structureless areas histologically correlate with…?

A

Flattening of the rete ridges with pagetoid spread of melanocytes

82
Q

Describe the pattern of this lesion

Dx?

A

Diffuse reticular

Compound dysplastic nevus

83
Q

Describe the pattern of this lesion

Dx?

A

peripheral reticular network with central hyperpigmentation

Benign nevus

84
Q

Describe the pattern of this lesion

A

Peripheral reticular with central hypopigmentation

Benign nevus

85
Q

Describe the pattern of this lesion
Dx?

A

Patchy reticular pattern

Dysplastic nevus

86
Q

Describe the pattern of this lesion

Dx?

A

Diffuse reticular pattern (asymmetric silhouette)

Junctional dysplastic nevus

87
Q

Describe the pattern of this lesion
Dx?

A

Homogeneous pattern

few globules

Congenital nevus

88
Q

Describe the pattern of this lesion
Dx?

A

Homogeneous blue pattern

Blue nevus

89
Q

Describe the pattern of this lesion

Dx?

A

Homogeneous pattern (tan to pink color)

Dysplastic nevus

90
Q

Describe the pattern of this lesion
Dx?

A

Homogeneous pattern

Congenital nevus

91
Q

Describe the pattern of this lesion

Dx?

A

Peripheral reticular network with central globules

Congenital nevus

92
Q

Describe the pattern of this lesion

Dx?

A

Peripheral globules (growing nevus)

Benign nevus

93
Q

Describe the pattern of this lesion

Dx?

A

Strarbust pattern with radial streaks

Spitz nevus

94
Q

Describe the pattern of this lesion

Dx?

A

Starbust pattern

Spitz nevus

95
Q

Describe the pattern of this lesion

Dx?

A

Globular pattern

Benign nevus

96
Q

Describe the pattern of this lesion

Dx?

A

Globular (cobblestone) pattern

Congenital nevus

97
Q

Describe the pattern of this lesion

Dx?

A

Two component pattern

reticular - globular

Benign nevus

98
Q

Describe the pattern of this lesion

Dx?

A

Organized multicomponent pattern with dots/globules, network, and homogenous areas

Benign nevus

99
Q

Describe the pattern of this lesion

Dx?

A

Organized multicomponent pattern with dots/globules, network, and homogenous areas

Benign nevus

100
Q

Describe the major dermoscopic finding in this lesion

Dx?

A

Atypical pigment network

Melanoma in situ

101
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • atypical network
  • scar-like depigmentation
  • peripheral brown structureless areas

Melanoma

102
Q

Describe the major dermoscopic finding in this lesion

Dx?

A

Atypical patchy network pattern

Melanoma in situ

103
Q

Describe the major dermoscopic findings in this lesion

Dx?

A

Atypical pigment network

Blue white veil

Dysplastic nevus

Case highlighting the limitations of dermoscopy

104
Q

Describe the major dermoscopic findings in the upper & lower image

Dx? (same lesion)

A
  • Upper: NPD
  1. peripheral patchy network
  2. asymmetric homogenous area
  • Lower: PD
    1. Chrysaline structures

Microinvasive melanoma

105
Q

Describe the major dermoscopic finding in this lesion

Dx?

A

Presence of negative network

Melanoma

106
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • focal network
  • peripheral tan structureless areas
  • numerous irregular linear and serpentine blood vessels (polymorphic)

Melanoma

107
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • focal streaks
  • peripheral tan structureless areas

Melanoma

108
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • Diffuse reticular network
  • Bluish globules focale distributed
  • Atypical pigment network (upper-right part)

Melanoma (bluish globules) arising within a dysplastic nevus

109
Q

Describe the major dermoscopic finding in this lesion

Dx?

A

Disorganized homogeneous pattern

Nodular melanoma

110
Q

Describe the major dermoscopic findings in images A vs B,

Dx? (Same lesion)

A
  • A) NPD:
  1. regression structures
  2. blue-white veil
  3. irregular globules
  4. peripheral tan structureless areas
  • B) PD: chrysalis structures

Melanoma

111
Q

Describe the major dermoscopic finding in this lesion

Dx?

A
  • Relatively structureless pink pattern
  • Presence of dotted vessels

Melanoma

112
Q

Describe the major dermoscopic findings in this lesion

Dx?

(photos: follow-up over 4mo )

A

Homogeneous structureless lesion

Melanoma

113
Q

Describe the major dermoscopic finding in this lesion

Dx?

A

Atypical globular pattern

Melanoma

114
Q

Describe the major dermoscopic findings in images A vs B,

Dx? (Same lesion)

A
  • A) NPD:
  1. negative network
  2. peripheral tan structureless areas
  • B) PD:
    1. crystalline structures

Melanoma

115
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • asymmetric multicomponent pattern
  • irregular globules
  • peripheral structureless areas
  • atypical network
  • peripheral blotch
  • blue-white veil

Melanoma

116
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • asymmetric multicomponent pattern
  • focal streaks, globules,
  • dotted vessels
  • structureless areas

Melanoma

117
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • atypical network
  • focal streaks
  • blue-white veil

Melanoma

118
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • disorganized homogenous pattern
  • peripheral blotch
  • focal regression structures

Melanoma

119
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • atypical network
  • peripheral blotch
  • irregular globules

Melanoma

120
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • Symmetric lesion
  • blue-white veil over raised area

Melanoma

121
Q

Describe the major dermoscopic findings in this lesion

Dx?

A
  • Symmetric lesion
  • peripheral atypical network
  • central negative network

Melanoma

122
Q

Name the ABCD rule

A

Assymetry

Border sharpness

Colors

Dermoscopic structures

Evolution (revised ABCD rule)

123
Q

How is assymetry according to ABCD rule defined?

A
  • The lesion is bisected by two lines that are placed 90° to each other
  • The first line attempts to bisect the lesion at the division of “most symmetry” and the other line is then placed 90° to it
  • Symmetry takes into account the contour, colors & structures within a lesion
124
Q

Scoring of assymetry in ABCD rule

A
  • If lesion symmetric in both axes = 0
  • If one axis symmetry = 1
  • If biaxial assymetry = 2

Scoring range: 0-2

125
Q

How is border sharpness defined in ABCD rule?

A
  • the lesion is divided into 8 equal pie-shaped pieces
  • Next, count the number of segments that have an abrupt perimeter cutoff

Scoring range: 0-8

126
Q

What colors are evaluated in ABCD rule?

A
  • Number of following colors present:
  1. light brown
  2. dark brown
  3. black
  4. red
  5. white​
  6. blue-gray

Scoring range: 0-6

127
Q

What dermoscopic structures are evaluated in ABCD rule?

A
  • dots
  • globules
  • structureless (homogeneous) areas
  • network
  • branched streaks

Scoring range: 0-5

128
Q

After you have evaluate a lesion according to ABCD rule, BNS?

A

Calculate Total Dermoscopy Score(TDS)

Linear equation

TDS range: 1.0-8.9

129
Q

Formula & coefficients utilized in multivariate analysis for determination of TDS

A
130
Q

TDS score for melanocytic neoplasms

A
131
Q

Cutoff values in ABCD rule

Benign

vs

Suspicious

vs

Malignant

A

Benign < 4,75

4,75 < Suspicuous < 5,45

Malignant > 5,45

132
Q

Exceptions to ABCD rule

A
133
Q

Schematic summary of ABCD rule

A
134
Q

Grade the assymetry according to ABCD rule in the following lesions (A,B,C)

Dx?

A
  • A) 0 , compound nevus
  • B) 1 , SSM
  • C) 2 , SSM
135
Q

Grade border sharpness according to ABCD rule in the following lesions (A,B,C)

Dx?

A
  • A) 0 , compound nevus
  • B) 4 (segments 3-6) , melanoma in situ
  • C) 8 , dysplastic nevus
136
Q

Grade color variegation according to ABCD rule in the following lesions (A,B,C)

Dx?

A
  • A) 2 ( light & dark brown) , junctional nevus
  • B) 4 ( light & dark brown,blue-gray, black) , melanoma in situ
  • C) 6 , SSM
137
Q

Grade dermoscopic structures according to ABCD rule in the following lesions (A,B,C)

Dx?

A
  • A) 1 (one structureless area) , compound nevus
  • B) ​3 [structureless areas (*), areas with network (=>), and branched streaks (→)] , SSM
  • C) 5 [structureless areas, network (=>), branched streaks (>), dots ( ), and pigmented globules (→)], SSM
138
Q

Menzies method features

A
  • based on 11 features ( 2 negative , 9 positive for melanoma)
  • scored as present or absent
  • reduces the intra- & interobserver errors
  • sensitivity of 92% & specificity of 71% for invasive melanoma
139
Q

Melanoma dx based on Menzies method requires…?

A
  • Absence of two negative features
  • At least 1 out of 9 positive features
140
Q

Name the 2 negative features of Menzies method

A
  • Symmetry of pigmentation pattern:
  1. symmetry of all pattern structures, including color along any axis through the center (of gravity) of a lesion
  2. does not require symmetry of shape
  • Single color:
  1. White is not scored
  2. single color excludes the diagnosis of melanoma
141
Q

Name the 9 positive features of Menzies method

A
  • blue-white veil
  • multiple brown dots
  • focal pseudopods
  • focal radial streaming
  • scar-like depigmentation
  • peripheral black dots/globules
  • 5-6 colors,
  • multiple blue-gray dots/peppering
  • focally broadened network
142
Q

Menzies method (table)

A
143
Q

Positive features of Menzies method

A
144
Q

Evaluate symmetry in the following patterns according to Menzies method

A
  • A) Symmetrical pigmentation pattern (symmetry of pattern/texture over all axes through the center of gravity. It does not require symmetry of shape)
  • B) Symmetrical pigmentation pattern (despite asymmetry of shape)
  • C) Asymmetric pigmentation pattern ( lacks symmetry over short axis)
145
Q

Evaluate this lesion according to Menzies method

Dx?

A

Symmetrical pigmentation pattern (hence not malignant)

Junctional acral nevus

146
Q

Evaluate this lesion according to Menzies method

Dx?

A

Symmetrical pigmentation pattern

(asymmetry of shape doesn’t matter)

Dysplastic nevus

147
Q

Evaluate this lesion according to Menzies method

Dx?

A
  • Not symmetrical pigmentation pattern
  • Not single color ( > 4 )
  • Peripheral globules
  • Broadened network

Melanoma

148
Q

Evaluate this lesion according to Menzies method

Dx?

A
  • Not symmetrical pigmentation pattern
  • Not single color ( > 4 )
  • Blue-white veil

Melanoma

149
Q

How to differentiate pseudopods vs globules?

A
  • Pseudopods need to:
  1. directly connected to the tumor
  2. have a maximum diameter larger than the atypical network from which it originates
150
Q

In the following drawing which knobs can be characterized as pseudopods?

A

3,4

1 - lacks connection to the tumor body

2 - has smaller diameter from the network from which it originates

151
Q

Evaluate this lesion according to Menzies method

Dx?

A
  • Asymmetrical pigmentation pattern
  • Multiple colors
  • Scar-like depigmentation

Melanoma

152
Q

Evaluate this lesion according to Menzies method

Dx?

A
  • Asymmetrical pigmentation pattern
  • Multiple colors > 5
  • Blue-white veil
  • Scar-like depigmentation
  • Broadened network

Melanoma

presence of ^ vasculature can lead to multiple colors

153
Q

Evaluate this lesion according to Menzies method

Dx?

A
  • Absence of negative features
  • Multiple blue-gray dots ( black arrows)
  • Blue-white veil (red arrow)

Melanoma

154
Q

Evaluate this lesion according to Menzies method

Dx?

A
  • Absence of negative features
  • BWV ( black arrow)
  • Focal broadened network (red arrow)

Melanoma

155
Q

Evaluate this lesion according to Menzies method

Dx?

A
  • Symmetrical pigmentation pattern ( over the center of gravity)
  • 2 colors
  • Peripheral globules

Compound nevus

156
Q

Evaluate this lesion according to Menzies method

Dx?

A
  • Absence of negative features
  • Absence of positive features

Dysplastic nevus

157
Q

Evaluate this lesion according to Menzies method

Dx?

A
  • Absence of negative features
  • Multiple blue-gray dots (arrows)

Lentigo melanoma

158
Q
A

Δερματοσκόπηση (4 decks)

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