Dermatology: Practical and Conceptual


Image Letter  |  Dermatol Pract Concept 2019;9(3):6 207

Dermatology Practical & Conceptual

A Tiny Melanoma: The Beginning of a Life
Aimilios Lallas1, Chryssoula Papageorgiou1, Christina Nikolaidou2, Zoe Apalla3

1 First Department of Dermatology, Aristotle University, Thessaloniki, Greece

2 Department of Histopathology, Hippokration General Hospital, Thessaloniki, Greece

3 State Clinic of Dermatology, Hospital for Skin and Venereal Diseases, Thessaloniki, Greece

Key words: melanoma in situ, dermoscopy, diagnosis

Citation: Lallas A, Papageorgiou C, Nikolaidou C, Apalla Z. A tiny melanoma: the beginning of a life. Dermatol Pract Concept. 
2019;9(3):207-208. DOI: https://doi.org/10.5826/dpc.0903a06

Accepted: May 2, 2019; Published: July 31, 2019

Copyright: ©2019 Lallas et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Aimilios Lallas, MD, PhD, First Department of Dermatology, Aristotle University, 124 Delfon Street, Thessaloniki, 
Greece. Email: emlallas@gmail.com

Case Presentation

A 54-year-old man without personal or family history of 

melanoma was examined during a skin cancer screening 

campaign. The clinical examination revealed numerous nevi, 

angiomas, and seborrheic keratoses, all smaller than 5 mm 

and without morphological atypia (Figure 1A).

Surprisingly, the dermoscopic examination of a 2-mm-

sized lesion (Figure 1B) on his thorax revealed irregularly 

shaped hyperpigmented areas, a feature recently proposed 

to typify melanoma in situ (Figure 1C) [1]. The lesion was 

excised with a 4-mm punch, and histopathology revealed 

an intraepidermal lentiginous and focally nested mela-

nocytic proliferation with moderate to severe cytologi-

cal atypia and pagetoid spread. The nests were variable 

in size and contained melanocytes with hyperchromatic 

cytoplasm. Immunostaining revealed hyperplasia and 

asymmetric distribution of intraepidermal melanocytes and 

confirmed the pagetoid spread. A diagnosis of melanoma 

in situ was rendered.

Teaching Point

Dermoscopy was introduced as a second-level method to 

further evaluate clinically preselected suspicious lesions. The 

size threshold for a lesion to be considered suspicious is 6 mm. 

Our case suggests that no size threshold should be used for 

dermoscopic examination, since dermoscopy has the potential 

to uncover even smaller melanomas and help to eradicate a 

potentially life-threatening tumor with a minimally invasive 

intervention.

Reference

1. Lallas A, Longo C, Manfredini M, et al. Accuracy of dermoscopic 

criteria for the diagnosis of melanoma in situ. JAMA Dermatol. 

2018;154(4):414-419.



208 Image Letter  |  Dermatol Pract Concept 2019;9(3):6

Figure 1. A tiny pigmented skin lesion on the chest, barely seen macroscopically (A). Close inspection reveals a 2-mm diameter brown macule 

(B). Dermoscopy reveals irregularly shaped hyperpigmented areas, raising the suspicioun of an early melanoma, which was histopathologi-

cally confirmed (C). [Copyright: ©2019 Lallas et al.]

A

C

B