Dermatology: Practical and Conceptual


Dermatology Practical & Conceptual

Image Letter | Dermatol Pract Concept. 2021:11(4); e2021112 1

Polypoid Melanoma: Towards a Dermoscopic 
Approach

Camilo Rojas-Erazo1, Fernando Valenzuela2, Laura Carreño3, Francisco González-Coloma2

1 Puerto Montt Hospital, Reloncavi Health Service, Puerto Montt, Chile

2 Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile

3 Pathology service, Clinical Hospital of the University of Chile, Santiago, Chile

Citation: Rojas-Erazo C, Valenzuela F, Carreño L, González-Coloma F. Polypoid melanoma: towards a dermoscopic approach.  
Dermatol Pract Concept. 2021:11(4); e2021112. DOI: https://doi.org/10.5826/dpc.1104a112

Accepted: March 8, 2021; Published: October 2021

Copyright: ©2021 Rojas-Erazo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 
License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original 
authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Francisco González-Coloma, Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile. 
Email: fgonzalezcoloma@gmail.com

Case Presentation

A 75-year-old man presented with a 2-inch exophytic lesion 

on the right gluteus with 1 year of progressive growth 

(Figure 1, A and B). Dermoscopy showed an irregular sero-

hematic crusty surface that impaired the observation of atyp-

ical polymorphic vessels and a peduncle with multicolored 

pattern: diffuse red and white background with irregular 

yellow, brown, and black areas (Figure 1C). Erythematous 

papules of the ipsilateral coxal region had a central red-

dish homogeneous pattern with a peripheral pigmented 

rim at dermoscopy (Figure 1D). Histopathology revealed 

a polypoid melanoma, Clark V level, Breslow thickness of  

14 mm, 12 mitoses/mm2, extensive ulceration, and perineural 

invasion. Coxal papules were satellite metastasis. The dis-

semination study was negative, yet limited, because of the 

patient’s death, 1 month later. 

Teaching Point

This rare and aggressive variant of nodular melanoma can be 

dermoscopically distinguished from clinically similar tumors 

by the recognition of irregular crusted-fibrinous surfaces, 

atypical polymorphic vessels, blue-white veils in the exophytic 

portion, a multicolored pattern, and blue-gray nests at the 

base [1, 2].



2 Image Letter | Dermatol Pract Concept. 2021:11(4); e2021112

References

1. Cabrera R, Recule F. Unusual Clinical Presentations of Malig-

nant Melanoma: A Review of Clinical and Histologic Features 

with Special Emphasis on Dermatoscopic Findings. Am J Clin 

Dermatol. 2018;19(s1):15-23. DOI:10.1007/s40257-018-0373-6. 

PMID: 30374898.

2. Di Altobrando A, Patrizi A, Dika E, Savoia F. Cauliflower-like exo-

phytic mass on the skin: polypoid melanoma. Clinical, dermoscop-

ic, and histologic features. An Bras Dermatol. 2020;95(6):748-

750. DOI:10.1016/j.abd.2020.04.010. PMID: 33041156.

Figure 1. (A) Tumoral lesion on the right gluteus and erythematous papules on the ipsilateral coxal region. (B) Crusty and pigmented surface 

of the tumor. (C) Polarized dermoscopy (DermLite DL4W, magnification x10) reveals a multicolored pattern in the peduncle of the tumor 

and (D) homogeneous reddish center with pigmented periphery of satellite metastasis.