Biopsy guided by dermoscopy in cutaneous pigmented lesion - Case report
A 50-year-old white male physician, born and raised in Rio de Janeiro, was referred to our Dermatology Department for skin cancer screening. On physical examination, we observed a 3 cm blackened macula with an irregular border and more than one color on the right calf (). The patient told us that the lesion had appeared 10 years ago, showing progressive growth in recent months. He had a positive family history of melanoma. Dermoscopic examination showed a peripheral atypical pigmented network structure (more marked on the right of the lesion), brownish streaks in the central area and in the right periphery, a peripheral area with a black blotch and some globular structures, an amorphous area with a pseudofollicular opening and pseudocysts on the left of the lesion, beyond the veil in the center of the lesion ( e ).\nAs the lesion had some clinical aspects of seborrheic keratosis and the more suspicious dermoscopic findings were restricted to only a part of the lesion, we chose to perform an incisional biopsy (punch 4) in this area (with streaks). Histological examination showed confluent atypical melanocytes, occupying part of the epidermis and extending into the superficial dermis, several mitotic figures, and an inflammatory reaction in the dermis. A diagnosis of superficial spreading melanoma was rendered (Breslow thickness = 0.37 mm) ().\nThe lesion was then removed with a 1 cm margin, and the wound was left to heal by secondary intention. The histological examination of this surgical specimen just showed a residual inflammatory reaction. There were no other melanoma features. The area of the blotch seen on the dermoscopy was histologically related to acanthosis, papilomatosis, and extensive deposition of melanin pigment in the dermis (consistent with partial regression phenomenon) (). Thus, we found that the portion of the malignant lesion had been excised with incisional biopsy guided by dermoscopy.